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

Abstract

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.

The Gallbladder ofUranoscopus ScaberL. (Teleost Perciform Fish) is Lined by Specialized Cholecystocytes

“…Other cholesterol deposits can be fibrillar or curve-shaped accretions in lysosomes (Figs. 15,17) and resemble morphologically the intracellular types detected in cholecystitis (Kouroumalis et al, 1983b;Gilloteaux et al, 1997Gilloteaux et al, ,b, 2003Gilloteaux et al, , 2004 or cholesterolosis (Nevalainen and Laitio, 1972;Koga et al, 1975;Koga, 1985;Gilloteaux et al, 1997Gilloteaux et al, ,a, 2003Gilloteaux et al, , 2004Satoh and Koga, 1997). Some of those can reach more than 2 lm in diameter and are usually oblong in shape.…”

“…However, the presence of cholesterol crystals and deposits within fatty droplets and others in the lamina propria makes us raise the possibility that human diseases duplicate some ancient normal structures; further study of the peculiar and complex Uranoscopus cholecystocytes is indicated, as the cells of this organ bears a startling resemblance to alterations found in several human diseases, including cholesterolosis (Nevalainen and Laitio, 1972;Koga et al, 1975;Koga, 1985;Gilloteaux et al, 1997,a,b;Satoh and Koga, 1997) and cholecystitis (Gilloteaux et al, 2003(Gilloteaux et al, , 2004. It is also probable, as in human pathologic cholecystitis and cholesterolosis, that this species modifies the bile to its advantage by producing large amounts of mucins and, by the local high metabolism (mitochondria, peroxisomes) and liberating membranes, that is, where alkaline phosphatase is usually located in the bile, this reservoir to concentrate bile can alter its lipid composition (e.g., Glikerman et al, 1997;Tilvis et al, 1982;Kouroumalis et al, 1983a).…”

Asymptomatic gall stone disease: A clinicopathological correlation

“…Similar result was found by Goyal et al (2014) 6 who showed multiple stones are more common than single stone (72%). 19 Mixed stone was the most common type of stone (44.4%) in our study. Cholesterol and pigment stones were found in 29.6% and 25.9% cases, respectively.…”

Cystic duct directly joining the main pancreatic duct

“…Cholesterol in the bile juice is considered to be associated with cholesterolosis. 7 It is not easy to explain the pathogenesis of cholesterolosis in this case because the gallbladder epithelium was not exposed to bile juice. In a study of cholesterolosis in patients with chronic acalculous biliary pain, 8 20 of 32 patients with chronic cholecystitis had cholesterolosis, while 10 of these 20 had microlithiasis (stones less than 2 mm).…”