Cholesterosis of the Gall Bladder
1957; Elsevier BV; Volume: 32; Issue: 5 Linguagem: Inglês
10.1016/s0016-5085(57)80039-0
ISSN1528-0012
AutoresWilliam F. Mitty, Louis M. Rousselot,
Tópico(s)Cholangiocarcinoma and Gallbladder Cancer Studies
ResumoCholesterosis of the gall has been a known pathologic entity since 1857. The continuing occurrence of this problem at the Surgical Service of St. Vincent's Hospital of the City of New York, and the paucity of detailed in formation in current texts1• 3 and literature, prompted our review of past and present experience. This essay is a resume of 38 cases of cholesterosis of the gall bladder, with a review of the histopathology and physiopathology of this dis ease as well as a summation of our clinical experience with these patients. From a historical interest, many facets have been known for nearly a cen tury. Virchow in 1857 commented on the presence of a lipoid material in the epithelium of the mucosa of the gall obtained at necropsy. In 1896 Naunyn stated that he found increased concentration of cholesterol in the gall bile in cases of gallstones. He thought that this was due to secretory activity of the gall epithelium. In 1905 Sir Berkeley Moynihan 4 noted this disease in patients who were thought to be suffering from gall colic, but at operation the gall was described as normal with the blueness of health. It was he who first noted the peculiar appearance of the interior of the gall bladder. He described the mucosa as thickly dusted with fine stones. In 1910 McCarthy 5 popularized the term gall bladder for cho lesterosis because of the marked resemblance of the yellow specks on the mucosa to strawberry seeds. It is due to the monumental work of Boyd 6 that a clear understanding of the pathologic process is known. His methods of investigation were threefold: (a) the determination of the nature of the lipoid by special stains; (b) the use of the low-power binocular dissecting microscope, whereby a direct stereoscopic view of the mucosa could be obtained; and (c) the use of the polarizing micro scope in order to determine the nature of the lipoid. When an unstained frozen section of a gall mucosa containing a lipoid is examined with the polar izing microscope the lipoid stands out in a most beautiful and brilliant manner, shining with a silver radiance which is accentuated by the surrounding darkness. HISTOPATHOLOGY In cholesterosis the lipoid is usually most abundant in the villi of the mucosa. Deposits are more marked in the epithelium covering the villi than in the lining of its intervening depressions. 7 The stroma of the villi also contains mononuclear
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