Morphological Study of Cholesterol Hepatolithiasis Report of Three Cases

Saito, Katsuhiko; Nakanuma, Y; Ohta, T.; Higashino, Yoshinobu; Yamamichi, Noboru; Kidani, E.

doi:10.1097/00004836-199010000-00020

Cited by 14 publications

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“…In 1990, Saito et al (10) reported three patients with intrahepatic cholesterol stones and described the characteristic histopathological features (compared with those of calcium bilirubinate stones) as follows: (a) the proliferation of peribiliary glands was rather mild, and the secretory activity of mucus from these glands seemed poor; (b) multiple calculi and cholesterol granulomas were present in the ductal walls or in the cystically dilated conduits of the peribiliary glands; and (c) cholesterol crystals or microcalculi were found in the smaller branches of the intrahepatic bile ducts of the affected hepatic lobe. In this study, patients with intrahepatic cholesterol stones showed less extensive fibrous thickening of the ductal wall, less inflammatory cell infiltration and fewer mucous glands in the ductal wall than did patients with calcium bilirubinate stones.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, intrahepatic cholesterol gallstones are found in the peripheral intrahepatic bile ducts (9). These cholesterol stones do not migrate from the gallbladder but rather are presumed to be formed mainly in the intrahepatic biliary tree (8)(9)(10). The prerequisite for cholesterol stone formation in the gallbladder is believed to be the presence of cholesterolsupersaturated bile or lithogenic bile (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, cholesterol stones are said to be rare in hepatolithiasis. However, several groups of investigators (8)(9)(10) have reported increased incidences of cholesterol stones in hepatolithiasis and described the mechanism of their formation in the intrahepatic biliary tree.…”

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Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol stones, including immunohistochemical staining against apolipoprotein A-1

et al. 1993

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Apolipoprotein A-1 is known to be one of inhibiting factors of cholesterol nucleation in bile, and decreased activity of apolipoprotein A-1 is considered to predispose cholesterol-supersaturated bile to formation of cholesterol crystals. To study the pathogenesis of the intrahepatic formation of cholesterol stones, we examined surgically resected liver specimens from six patients with intrahepatic cholesterol stones and compared the characteristic histopathological features with those of intrahepatic calcium bilirubinate stones, using morphological examination and immunohistochemical staining against apolipoprotein A-1. Morphologically, in all six patients with cholesterol stones the severity of chronic proliferative cholangitis with proliferation of the mucus-producing glandular elements in the walls of the large bile duct or periductal tissues was less extensive than that seen with calcium bilirubinate stones, and cholesterol crystals had formed in the septal and interlobular bile ducts. Immunohistochemically, unlike the normal liver and calcium bilirubinate stone-containing lobes, the hepatocytes and the epithelial lining of the bile ducts and peribiliary glands of the cholesterol stone-containing lobes did not react completely (some of the epithelial cells reacted only faintly) with apolipoprotein A-1 antibody. These findings suggest that an abundance of mucous substance and bacterial infection of the biliary tree may not be necessary for the formation of cholesterol stones, compared with findings in cases of calcium bilirubinate stones. We suggest that cholesterol crystals may be produced in the septal and interlobular bile ducts in the microenvironment of cholesterol-supersaturated bile and decreased activity of apolipoprotein A-1.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol stones, including immunohistochemical staining against apolipoprotein A-1

et al. 1993

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“…6 Cholesterol stones are less common and associated with milder clinical symptoms and less fibroinflammatory changes of the bile ducts. 50 Mixed stones have a varying chemical composition between those of calcium bilirubinate stones and cholesterol stones. These stones have a smooth 1-mm black-surface outer shell surrounding a yellowish inner matrix and are hard in consistency, ovoid or faceted in shape.…”

Section: Stonesmentioning

confidence: 99%

Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

et al. 2011

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Primary hepatothiasis (HL) and recurrent pyogenic cholangitis (RPC) are two terms describing the different aspects of the same disease, with HL emphasizing the pathologic changes and RPC emphasizing the clinical presentation and suppurative inflammation. It is predominantly a disease of the Far East. In the 1960s, it was the third most common cause of emergency abdominal surgery at a university hospital in Hong Kong. Thereafter, its incidence has decreased considerably, possibly due to improved standards of living and Westernized diet. Clinically, patients may present acutely with recurrent bacterial cholangitis and its possible complications, such as liver abscess and septicemic shock, or with chronic complications, such as cholangiocarcinoma. Pathologically, it is characterized by pigmented calcium bilirubinate stones within dilated intrahepatic bile ducts featuring chronic inflammation, mural fibrosis, and proliferation of peribiliary glands, without extrahepatic biliary obstruction. Episodes of suppurative inflammation cumulate in sclerosing cholangitis of peripheral ducts and parenchymal fibrosis resulting from collapse and scarring. Mass-forming inflammatory pseudotumor and neoplasms like intraductal papillary neoplasms and cholangiocarcinoma are increasingly recognized complications. Modern imaging techniques allow definitive diagnosis, accurate assessment for treatment planning, and detection of complications. A multidisciplinary team approach (interventional endoscopist, interventional radiologist, hepatobiliary surgeon, and intensivists) is important for optimal patient outcome.

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“…The inflammatory and fibrotic changes around the bile duct wall were scanty (Fig. 4D) (5,9). It is presumed that the formation of primary cholesterol hepatolithiasis requires both the secretion of supersaturated bile and the presence of bile stasis (10) (7,8).…”

Section: F I G U R E 3 E N D O S C O P I C R E T R O G R a D E C H mentioning

confidence: 99%

Primary Cholesterol Hepatolithiasis Associated with Cholangiocellular Carcinoma: A Case Report and Literature Review

et al. 2007

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Morphological Study of Cholesterol Hepatolithiasis Report of Three Cases

Cited by 14 publications

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Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol stones, including immunohistochemical staining against apolipoprotein A-1

Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol stones, including immunohistochemical staining against apolipoprotein A-1

Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

Primary Cholesterol Hepatolithiasis Associated with Cholangiocellular Carcinoma: A Case Report and Literature Review

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