Cholesterol crystal morphology in acalculous gallbladder disease.
BACKGROUND
Biliary crystal morphology is best described in patients with gallbladder stones, but most patients undergoing bile collection for microscopy have a clinical diagnosis of acalculous gallbladder disease. We investigated the morphology of biliary crystals in such patients.


METHODS
Bile was obtained for polarizing microscopy from fresh cholecystectomy specimens of patients with a clinical diagnosis of acalculous or calculous gallbladder disease. Slides for microscopy were prepared by touch contact with bile in freshly opened gallbladder specimens, and following aspiration of gallbladder bile through a 5-French cannula.


RESULTS
Bile was examined from five patients with a clinical diagnosis of acalculous gallbladder disease and five patients with known gallstones. Needle-like cholesterol crystals predominated in most patients without gallstones, whereas plate-like and dot-like crystals were more common in patients with gallstones. All three crystal types were seen in most patients. Crystal morphology was not affected by aspiration of bile through a 5-French cannula.


CONCLUSIONS
Birefringent needles and dots should be recognized as cholesterol crystals during bile microscopy. These crystal morphologies may predominate in some patients with a clinical diagnosis of acalculous gallbladder disease.
Landi
Kristin
K
Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.
Sinard
John
J
Crawford
James M
JM
Topazian
Mark
M
D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry; D001659:Biliary Tract / Q000503:physiopathology; D002137:Calculi / Q000737:chemistry / Q000648:ultrastructure*; D002675:Child, Preschool; D002764:Cholecystitis / Q000175:diagnosis / Q000209:etiology; D002784:Cholesterol / Q000737:chemistry*; D003460:Crystallization; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008859:Microscopy, Polarization; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity
D002784:Cholesterol