Cholesterosis of the gall-bladder: A clinical and experimental study

Hawkins

et al. 1997

Microsc. Res. Tech.

Although there is a large body of data on the gallbladder and the importance of the cystic duct in surgical procedures, there is insufficient data regarding the morphology of the human cystic duct. In the present study, transmission electron microscopic (TEM) and scanning electron microscopic (SEM) survey of several surgical and autopsy cystic ducts in cholelithiasis and cholesterolosis is reported. In cholelithiasis, similar to gallbladder epithelium, the cystic duct epithelial cells display minor‐to‐severe alterations of the epithelial surface accompanied by variable erosion of the epithelium. Areas of intact surface epithelium demonstrate microvilli‐covered cells coated by a rich glycocalyx and mucous production. In other areas, apical excrescences are associated with mucus hyperproduction and secretory events. Lipoid bodies are also present in many cells and especially in many of the cells' subluminal apical areas. In cholesterolosis, mucous secretory granules appear dilated, fatty deposits are infrequent, and peculiar intracellular cholesterol deposits can be detected in the apical and subapical region of cells and around condensed mitochondria. Following elective cholecystectomies, predominantly in association with cholelithiasis, eroded areas were detected; therefore, it appears that the action of intraluminal calculi may be a principal causative factor in discrete epithelial erosions of the cystic duct. Intraluminal calculi/debris, along with the alteration of mucus, cell sloughing, and a decreased pool of bile acids and motility may participate in the gallstone nucleation process. The peculiar cholesterol inclusions may also play a role in that nucleating process. Microsc. Res. Tech. 39:22–38, 1997. © 1997 Wiley‐Liss, Inc.

Section: Cholelithiasismentioning

confidence: 93%

Ultrastructural aspects of human cystic duct epithelium as a result of cholelithiasis and cholesterolosis

Hawkins

et al. 1997

Microsc. Res. Tech.

Journal of Experimental Medicine

“…Boyd (3) did not actually measure the cholesterol content of gall bladder bile, but drew his conclusions from histologic studies and from changes in the cholesterol content of the blood after cholecystectomy. Illingworth (9) concluded from experiments on two cats that when cholesterol is present in excess it can be absorbed. He gave no data on the amount of fluid in the gall bladder at the time of autopsy.…”

Section: Discussionmentioning

confidence: 99%

“…The polemic is an old one, having been carried on for years by Aschoff (2) and Naunyn (12). The literature on this subject has been fully reviewed (6,9,10). Data on this controversial point are important because of the relationship which cholesterol bears to calculus formation.…”

Section: (From the Laboratory Of Research Surgery University Of Pennmentioning

confidence: 99%

Studies on Gall Bladder Function

Riegel

Johnston

Ravdin

1932

Eleven years have passed since Rous and McMaster (15) published their paper on the concentrating activity of the gall bladder. This contribution and subsequent ones by them and their associates renewed the interest of investigators in this organ. Two schools have developed, each with a different fundamental concept of gall bladder function. The one, following what would appear to be the more logical concept, maintains that concentrated bile is emptied at intervals into the duodenum. The other, largely from teleological reasoning, believes that the cystic duct is a one-way tube, permitting hepatic bile to flow into the gall bladder, but preventing it from flowing out. Those who accept the latter concept must necessarily adhere to the theory that every constituent of the bile is absorbed through the gall bladder wall. If the latter group is correct there must be an optimum concentration for "different constituents of the bile at which level they are absorbed at a definite rate.The experiments of Rous and McMaster indicated that bile pigment was not absorbed through the gall bladder wall. If this is true, and if the gall bladder has no other way of evacuating itself except by absorption, it would not take long for the lumen to be filled with an inspissated mass of pigment. The experiments on the pigment changes of hepatic bile subjected to gall bladder activity were open to certain errors which Rous and McMaster duly considered. The experiments were not absolutely quantitative in that the amountof hepatic bile entering the gall bladder could not be absolutely measured.

“…This disease has been well studied since being first described by Moynihan in 1909. According to previous histological and biochemical studies, lipid droplets accumulate in the submucosa, particularly in the protruding folds and consist mostly of cholesterol ester (Boyd, 1922;Illingworth, 1929;Mackey, 1941). The number of electron microscopic studies reported to date are small (Hora and Schultz, 1970;Luciano and Wolpers, 1973;Nevalainen and Laitio, 1972).…”

Section: Introductionmentioning

confidence: 99%

Fine structure of cholesterolosis in the human gallbladder and the mechanism of lipid accumulation

Satoh

Koga²

1997

Microsc. Res. Tech.

Gallbladders with cholesterolosis removed surgically for cholelithiasis were studied by light and electron microscopy as well as by cytochemical methods to demonstrate the presence of free cholesterol in the epithelial cells. Lipid droplets were found not only in the submucosa, but also in the infranuclear cytoplasm of epithelial cells. These contained well developed mitochondria and an agranular endoplasmic reticulum. Macrophages were often present between the epithelial cells and the submucosa, and protruded numerous processes, which also contained well developed cell organelles, abundant lysosomes and lipid droplets. With the excessive lipid deposition, macrophages were filled with lipid droplets and became foam cells. In the epithelial cells, many reaction precipitates occurred after digitonin treatment and some of them were observed in the endoplasmic reticulum. It is suggested, therefore, that free cholesterol is absorbed by epithelial cells and thereafter becomes esterified in the endoplasmic reticulum and thus appears as lipid droplets. Lipid droplets synthesized in the epithelial cells may then be released into the intercellular space, and phagocytosed there by macrophages. It is thus suggested that macrophages filled with lipid droplets may become too large and rigid to pass through the endothelium of lymph vessels, and those large “foam cells” may cause the destruction of lymph vessels. Those sequential events should eventually advance the accumulation of foam cells in the submucosa. Microsc. Res. Tech., 39:14–21, 1997. © 1997 Wiley‐Liss, Inc.