PubMed · 8686187
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M Brodanová. 1996. [Cholelithiasis--introduction to its problems].. https://pubmed.ncbi.nlm.nih.gov/8686187/
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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.
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Cholelithiasis is an extremely unusual finding in infancy. The following article describes the case of a 2-month-old male with a VACTER association who presented with persistent and progressive obstructive jaundice and acholic stool due to cholelithiasis. Thirty cases under the age of 1, including our case, have previously been reported in the Japanese literature. Twenty-eight cases had predisposing factors. The calculi were present only in the gallbladder in 18 cases, in the common bile duct or cystic duct or both in 7 cases, and in the gallbladder and common bile duct in 3 cases. Ten cases of stones were radiopaque, which thus made the plain abdominal roentgenogram findings very valuable. Nine cases underwent operation including cholecystectomy in 3 cases, choledocholithotomy in 3 cases, and cholecystolithotomy in 1 case, while the procedure was unknown in 2 cases. Recently, the number of reported cases of cholelithiasis in infants has gradually increased and today these cases are most often diagnosed by ultrasonography, because the examination is easy to perform and not invasive.