Pelvic Cholelithiasis. A Report of 4 Cases. (9th November 2022)

• Record Type: Journal Article
• Authors: Policarpio-Nicolas, M; Malenie, R; Joehlin-Price, A; Przybycin, C
• Is Part Of: American journal of clinical pathology. Volume 158(2022)Supplement 1
• Page Start: S85
• Page End: S85
• Publication Date: 2022-11-09
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqac126.177
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Introduction/Objective: Spillage of gallstones in the peritoneal cavity during laparoscopic cholecystectomy is a known intraoperative complication which could cause peritoneal irritation/abscess and occasionally present as ovarian cholelithiasis and pelvic mass. Our aim is to present the clinicopathologic findings of pelvic cholelithiasis in our institution. Methods/Case Report: A one year computerized natural language search for "Halls, bile, pigment, crystals" in surgical final diagnosis and comment was performed. The patients' demographic, clinical presentation & history of cholecystectomy were collected from the medical records. The pathologic findings were reviewed. Results (if a Case Study enter NA): We identified 4 women with an age range of 45-52 (mean=50). Three patients presented with abnormal uterine bleeding and one patient was admitted for sterilization. The time interval from cholecystectomy was 3-26 years (mean=18).Intra-operative findings were as follows: Case 1: blue-black 5 mm lesion located in the right ovary, Case 2: yellow-surface nodularity of left ovary and <1 cm white lesion in posterior cul- de sac, Case 3 two left ovarian cysts (0.8 and 1.5 cm), and Case 4 for sterilization showed a 0.3 cm. brown peritoneal lesion and unremarkable fallopian tubes. The histologic findings revealed bile pigment/crystals overlying the surfaces of the ovaries (3) peritoneum (1), & pelvis (1) with fibrosis and foreign-body giant cell reaction. The pathologic diagnosis was made in conjunction with prior history of cholecystectomy. Halls bilirubin stain was positive in 2/2 cases. Conclusion: Pelvic cholelithiasis is an incidental finding in pre and post-menopausal women often involving the ovaries, peritoneum and pelvis. Intra-operatively, it could mimic endometriosis and pelvic mass. Histologic findings show bile pigment/crystals on serosal surface with fibrosis and foreign-body giant cell reaction. Familiarity with the histologic findings in conjunction with history of cholecystectomy is helpful in arriving at the correct diagnosis.