Cholesterosis of the gall-bladder a further contribution to the histology of this condition

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.

“…There is general agreement that it secretes various substances but controversy has been centred on the problem of whether it secretes or absorbs cholesterol. As a result of investigations on cholesterosis, Elman & Graham (1932) championed the cause of secretion, while Illingworth (1929) and Mackey (1937and Mackey ( , 1941 have presented evidence that cholesterol is absorbed from material in the lumen of the organ. Experiments on epithelial permeability have been made by Winkenwerder (1929) and Cooke (1932), and the mucous cells of the epithelium have been the subject of study by Ito & Nagahiro (1942) and by Gallinaro (1947).…”

Section: ( D ) Gall-bladder and Biliary Passagesmentioning

confidence: 99%

The Cytology of Wound Healing of Body Surfaces in Mammals

Johnson¹,

McMinn²

1960

Biological Reviews

SUMMARY The cytological aspects of the repair of wounds with loss of substance in the skin, cornea and a number of mucous, serous and synovial membranes in mammals (laboratory animals and man) have been reviewed. It is emphasized that, as in the last century, the majority of studies of wound healing continue to be carried out on skin, and the need for examining repair processes in other organs is stressed. While most of the evidence indicates that epithelium regenerates from old epithelium at the wound margin, the surfaces of serous and synovial membranes are probably repaired by metaplasia of underlying connective tissue cells, assisted by the implantation of islands of surface cells that have desquamated from adjacent surfaces. The epithelia of the gall‐bladder and urinary bladder (in the cat) display abundant evidence of mitosis in migrating cells. Mitosis in spreading cells has also been observed in ileal and rectal epithelium. While migration remains a primary factor in epithelial repair, the role of mitosis has possibly been underestimated in the past. The origin of the connective tissue cells of granulation tissue remains an enigma. There is evidence suggesting that the fibrocytes of the dermis do not proliferate, and that new connective tissue cells are haematogenous in origin. The endothelial (vascular and lymphatic) elements of granulation tissue originate by budding from pre‐existing vessels. There is doubt whether mitosis occurs in such endothelial cells. In the repair of mucous membranes in the alimentary tract, new gland formation is observed regularly in the stomach, duodenum and ileum in all the species that have been investigated, including man. The colon and rectum appear to exhibit less regenerative capacity than higher levels of the alimentary tract, for there is no consistent evidence for new gland formation in these viscera. No universally applicable explanation is yet forthcoming for the accumulation of glycogen that can be detected histochemically in many, but not all, of the regenerating epithelia that have so far been studied. Among the urgent items on which cytological research might be prosecuted in the future are: the possible role of metaplasia of connective tissue cells in the production of new epithelium, mitosis in migrating epithelium, the factors regulating the initiation and cessation of mitosis, the problem of the origin of new connective tissue cells, and the causes of contraction. Compared with the number of purely morphological studies, histochemistry and autoradiography have not often been wedded to the problems of repair, while the whole field of wound healing at the cellular level awaits study with the electron microscope.

“…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.