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| IMAGE QUIZ |
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| Year : 2016 | Volume
: 4
| Issue : 3 | Page : 242-244 |
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An enigma of the gallbladder
Saja A Alaqeel, Faten O Alaqeel, Khaldoon A Saleh, Abdulmohsen A Al-Mulhim
Department of Surgery, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| Date of Web Publication | 11-Aug-2016 |
Correspondence Address:
Abdulmohsen A Al-Mulhim
Department of Surgery, King Fahd Hospital of the University, P.O. Box 1917, Al-Khobar 31952
Saudi Arabia
 DOI: 10.4103/1658-631X.188270 PMID: 30787743 
How to cite this article:
Alaqeel SA, Alaqeel FO, Saleh KA, Al-Mulhim AA. An enigma of the gallbladder. Saudi J Med Med Sci 2016;4:242-4 |
A 45-year-old Saudi housewife underwent elective laparoscopic cholecystectomy for biliary colic.
The mucosa of the excised gallbladder is shown in [Figure 1]a,[Figure 1]b. | Figure 1: (a) Mucosa of the gallbladder (b) Magnified gallbladder mucosa
Click here to view |
| Questions | |  |
- What are the findings?
- What is the diagnosis?
 View Answer
| Answers | | |
See the answer in page 244. | Answers | | |
- Yellow diffuse flat deposits on the gallbladder (GB) mucosa.
- Cholesterolosis.
| Discussion | | |
Cholesterolosis is a disorder of lipid metabolism that leads to increased accumulation of cholesterol in the GB mucosa. It is also known as “strawberry GB” because of its golden yellow speckled pattern on gross examination. Histologically, there are plenty of foamy macrophages in the lamina propria and epithelium. Cholesterolosis is a common histopathologic finding being reported in 13–25% of cholecystectomy specimens. [1],[2],[3],[4],[5] Its pathogenesis and etiology are not understood. It is more common in patients under 60 years of age and can be found in cases with and without gallstones. [1],[3] Hence, it is controversial whether cholesterolosis is an incidental finding in cholecystectomy specimens or a cause of biliary symptoms, pancreatitis, or high cholesterol level. [1],[4] Furthermore, its role in metaplasia-neoplasia-carcinoma sequence of GB cancer is obscure. [3],[4] The preoperative diagnosis of cholesterolosis by routine laboratory tests and abdominal ultrasound is usually not possible. [2]Despite it was first described by Virchow more than 100 years ago, cholesterolosis remains an enigma.
| References | | |
| 1. | Khairy GA, Guraya SY, Murshid KR. Cholesterolosis. Incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy. Saudi Med J 2004;25:1226-8.  [ PUBMED] |
| 2. | Dairi S, Demeusy A, Sill AM, Patel ST, Kowdley GC, Cunningham SC. Implications of gallbladder cholesterolosis and cholesterol polyps? J Surg Res 2016;200:467-72. [ PUBMED] |
| 3. | Meirelles-Costa AL, Bresciani CJ, Perez RO, Bresciani BH, Siqueira SA, Cecconello I. Are histological alterations observed in the gallbladder precancerous lesions? Clinics (Sao Paulo) 2010;65:143-50. |
| 4. | Yaylak F, Deger A, Ucar BI, Sonmez Y, Bayhan Z, Yetisir F. Cholesterolosis in routine histopathological examination after cholecystectomy: What should a surgeon behold in the reports? Int J Surg 2014;12:1187-91. [ PUBMED] |
| 5. | Ozgur T, Toprak S, Koyuncuer A, Guldur M, Bayraktar G, Yaldiz M. Do histopathologic findings improve by increasing the sample size in cholecystectomies? World J Surg Oncol 2013;11:245. [ PUBMED] |
[Figure 1]
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