Prevalence of 12% in autopsy studies and from 9-26% in surgical pathology studies
• Usually asymptomatic and discovered incidentally at cholecystectomy
Clinical significance, if any, is unclear
• Peak in 5th and 6th decades of life
Macroscopic
• Cholesterolosis
Lipid droplets appear as yellow flecks or streaks against green or red background (strawberry gallbladder)
• Cholesterol polyps
Foamy macrophages form polypoid excrescences that project into lumen
• Diffuse cholesterolosis is most common pattern (∼ 80%)
Mixed cholesterolosis and polyps, or polyps alone, less common (∼ 10% each)
Microscopic
• Foamy macrophages with small dark nuclei accumulate in lamina propria of gallbladder mucosa
• Cholesterol polyps have lobulated architecture, vascular stalk
• Cholesterolosis may result in thickened folds &/or polyps
• Minimal inflammation unless there are concomitant gallstones
Strawberry Gallbladder This gross photograph of a gallbladder with cholesterolosis shows numerous yellow dots against red-brown mucosa in the background, somewhat resembling a strawberry. In addition, there is a small cholesterol polyp .
Cholesterolosis Cholesterolosis features multiple villi with expansion of the lamina propria by numerous foamy macrophages .
Cholesterol Polyp This large cholesterol polyp has become detached from the underlying mucosa. The polyp is composed of foamy macrophages with overlying biliary mucosa and minimal inflammation.
Foamy Macrophages A high-power view shows expansion of a villous tip by numerous macrophages with expanded foamy clear cytoplasm. The foamy macrophages are similar in both cholesterolosis and cholesterol polyps.
TERMINOLOGY
Definitions
• Accumulation of neutral lipid within macrophages of lamina propria of gallbladder
ETIOLOGY/PATHOGENESIS
Pathogenesis
• Poorly understood
• May reflect increased hepatic synthesis of lipids or increased absorption and esterification by gallbladder
• Frequently occurs with cholesterol gallstones in setting of supersaturated bile
CLINICAL ISSUES
Epidemiology
• Incidence
Cholesterol polyps account for 50-60% of all gallbladder polyps
Prevalence rate of 12% in autopsy studies and from 9-26% in surgical studies
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