Morphological criteria of gallbladder destruction in patients with acute cholecystitis, which occurred against the background of COVID-2019

Abstract

The aim of the work: to study the morphological features of the gallbladder of acute cholecystitis, which occurred against the background of COVID-2019.
 Materials and Methods . Material for histological studies was collected from the proximal and middle third of the gallbladder, as well as from the fundus. The obtained fragments of the gallbladder wall after fixation in a 10 % solution of neutral buffered formalin were processed in the LogosOne histoprocessor and embedded in paraffin blocks. Tissue sections with a thickness of 5 μm obtained on an AMR400 rotary microtome were stained with hematoxylin and eosin. The obtained histological preparations were examined using a Nikon Eclipse Ci-E light microscope. A Sigeta M3CMOS14000 digital video camera with Toup View software was used for photo documentation. With the help of this program, morphometry of tissue structures was also carried out. All histological preparations were divided into 2 groups – patients with acute cholecystitis and those with acute cholecystitis against the background of COVID-19.
 Results and Discussion. During the morphological examination of the gallbladder of patients in the cholecystitis + COVID-19 group, it was established that the thickness of the mucous membrane exceeded the similar indicator of the first group by 19.4 %, the differences regarding the muscular and serous membranes were insignificant – an increase of 2.2 % and 1.7 %. The height of covering epitheliocytes regressed by 21.8 %, and the relative volume of affected cells also increased significantly – by 26.0 %. The share of blood vessels increased by 14.4 % in the mucosa and by 9.8 % in the muscle. The described dynamics of morphometric parameters are relevant to the changes detected by microscopy. Thus, the thickening of the mucous membrane under the conditions of a combination of cholecystitis and COVID-2019 can be explained by more pronounced phenomena of edema and hyperemia of the mucous membrane. A decrease in the height of epitheliocytes and an increase in the proportion of damaged cells indicate more intense destructive changes in the epithelium. An increase in the proportion of blood vessels in different parts of the gallbladder wall does not indicate an improvement in its vascularization, but is instead a morphometric marker of the severity of hemodynamic disorders (dilatation and engorgement of vessels, thrombosis). In older people, there was a thinning of the muscle membrane by 11.6 %. Such a structural rearrangement, one should think, has a negative effect on the contractile function of the gallbladder, reduces the force of its tension and contraction. Based on the study of histological preparations, it can be stated that hemodynamic disorders and, in particular, thrombosis play an important role in the pathogenesis of acute cholecystitis, which occurs against the background of COVID-2019.