Distribution Of The Human Gallbladder Interstitial Cajal Cells In Chronic Calulous Cholecystitis And Gallbladder Adenocarcinoma

Chronic cholecystitis is usually caused by repeated attacks of acute sudden cholecystitis. Most of these attacks are caused by gallstones in the gallbladder. These attacks cause the walls of the gallbladder to thicken. The gallbladder begins to shrink. Over time, the gallbladder is less able to concentrate, store, and release bile. Commonly, chronic cholecystitis is seen more frequently in women than men, and the incidence of this condition usually rises after age forty. The main risk factor for chronic cholecystitis often is gallstones. In this case of chronic cholecystitis, the symptoms the patient experiences are similar those normally caused by gallstones. Symptoms usually include upper right quadrant abdominal pain that may be accompanied by nausea and vomiting. About9out of10gallbladder cancers are adenocarcinomas. An adenocarcinoma is a cancer that starts in the cells with gland-like properties that line many internal and external surfaces of the body. Both of chronic calulous cholecystitis and gallbladder adenocarcinoma are accompanied with gallbladder dysfunction. Gastrointestinal motility disorders are a serious problem in both veterinary and human medicine and may represent a dysfunction of the neural, muscular or pacemaker components of bowel control. The interstitial cells of Cajal are considered to be the pacemakers and mediators of certain forms of neurotransmission in the gastrointestinal tract. These cells have been implicated, either primarily or secondarily, in the pathogenesis of gastrointestinal disease processes. Damage to interstitial cells of Cajal and reduction of its population has been described in almost every GI motility disorder from the esophagus to the rectum. There is already a significant body of evidence for the involvement of interstitial cells of Cajal in the pathophysiology of gastroparesis and constipation, but interstitial cells of Cajal abnormalities are also present in acquired conditions such as achalasia, intestinal pseudo-obstruction, and the inflammatory bowel disorders as well as congenital diseases such as Hirschsprung’s and congenital hypertrophic pyloric stenosis. Resembling the gastrointestinal tract, the bile duct system also shows spontaneous rhythmic motility, but the underlying mechanism is not clear. It has been repeatedly shown on previous occasions that pleiomorphic and/or spindle shaped cells, immunoreactive for CD117/c-kit, were present in some malignant/normal human gallbladder tumors. Another line of evident of evidence has been provided by a recent report about the presence of cells similar to interstitial cells of Cajal in CD1mice or guinea pig gallbladder, respectively.The purpose of this study was to show the presence, the distribution and ultrastructural characteristics of the interstitial cells of Cajal by means of a set of complementary techniques, such as single/double immunohistochemistry and high transmission electron microscopy in the gallbladder with chronic calulous cholecystitis and gallbladder adenocarcinoma.Objectives1. To verify the present of interstitial cells of Cajal in the gallbladder with chronic calulous cholecystitis or gallbladder adenocarcinoma.2. To compare the distribution of interstitial of Cajal in the different position of gallbladder (fundus, body, and neck).3. To compare the distribution of interstitial of Cajal in the gallbladder with chronic calulous cholecystitis and gallbladder adenocarcinoma.4. To observe the morphological and ultrastructural changes and spatial relationships of interstitial cells of Cajal, nerve, gallbladder SMC, and other surrounding cells.5. To discussion the mechanism of gallbladder dysfunction in chronic calulous cholecystitis.Methods1. Collect the clinical specimens of chronic calulous cholecystitis and gallbladder adenocarcinoma and observe.2. Observe the morphology and distribution of the interstitial cells of Cajal by c-kit immunohistochemistry and the relationships between the interstitial cells of Cajal and gallbladder smooth muscle cells/nerves by the means of c-kit with a-Actin/PGP9.5double immunohistochemistry,.3. Observe the morphological and ultrastructural changes and spatial relationships of interstitial cells of Cajal, nerve, gallbladder SMC, and other surrounding cells.Results1. There were interstitial cells of Cajal in the gallbladder of chronic calulous cholecystitis and gallbladder adenocarcinoma.2. The integrated option density (IOD) of c-kit positive cells showed a gradual increase from the fundus to neck of the gallbladder of chronic calulous cholecystitis and gallbladder, but there is no significant (p>0.05).3. The integrated option density (IOD) of c-kit positive cells showed no significant in chronic calulous cholecystitis vs gallbladder adenocarcinoma.4. There were interstitial cells of Cajal between lymphocytes.5. The results of the double immunohistochemistry displayed that the interstitial cells of Cajal ran occasionally parallel with the gallbladder smooth muscle cells, and there were no direct relationship between the interstitial cells of Cajal and nerves.6. The interstitial cells of Cajal appeared different morphological appearance and relationships with surroundings at transmission electron microscopy (TEM).Conclusions1. The interstitial cells of Cajal may play a important role in the gallbladder dysfunction.2. Gallstone and chronic inflammation may be involed in the gallbladder dysfunction of chronic calulous cholecystitis.3. Besides as pacemaker or neurotransmission mediators, the interstitial cells of Cajal may have other functions, such as phagocytosis and secretion.