Cholesterolosis as a clinical entity which has not been clarified completely by review of the literature and our experience

Öz

Background/aim: Cholesterolosis of the human gallbladder has long been considered as a histomorphological entity. Although its etiology has not been fully understood, recognition of cholesterolosis by the pathologist is easy. Recently it has been questioned whether it is a clinical as well as a histomorphological entity, and it has been reported that it could cause symptoms. Materials and methods: In the Pathology Department of SSK Gazi Hospital, we examined 118 cholecystectomy specimens of patients who were operated because of chronic cholecystitis and/or cholelithiasis and reviewed the histopathologic diagnoses regarding the existence of cholesterolosis. Results: We found cholesterolosis in 21 cases (11.6%) of 118 cholecystectomy specimens. All cases were female and ages ranged between 37 and 75 (median: 60). Eleven cases (5.8%) had cholesterolosis with chronic calculous cholecystitis and 8 cases (4.3%) had cholesterolosis with cholelithiasis. Remarkably, we found 2 cases (1.5%) in whose specimens cholesterolosis was the only histopathological finding. Conclusion: In the literature it has also been emphasized that cholesterolosis might cause clinical symptoms and that it should be suspected in patients with symptoms suggestive of biliary disease and with no abnormality on cholecystography or ultrasonography. When cholesterolosis is detected, an appropriate curative approach (clinical following symptomatic supportive treatment, and even cholecystectomy in patients with biliary colic episodes) would prevent the patient's suffering from being symptomatic.

Anahtar Kelimeler

• Cholesterolosis, gallbladder

Kişisel gözlemimiz ve literatürden derlenmiş bilgiler ışığında tam netleşmemiş bir klinik antite olarak kolesterolozis

Öz

Giriş ve amaç: Etyolojisi net olarak aydınlatılamamakla birlikte histopatolojik açıdan kolayca teşhis edilerek daha ziyade histomorfolojik bir antite olarak yaklaşılan safra kesesi kolesterolozisinin klinik açıdan da sorgulanmaya başlandığı görülmekte, semptomlara neden olabileceği bildirilmektedir. Kolesterolozise kolesistektomi spesmenlerinin %10- 25'inde rastlandığı belirtilmektedir. Gereç ve yöntem: SSK Gazi Hastanesi (TCDD Ankara Hastanesi) Patoloji departmanına gönderilen ve 1995-2004 yılları arasında klinikoultrasonografik olarak kolelityazis ve/veya kronik kolesistit tanısıyla opere edilen 118 olgunun kolesistektomi spesmenlerindeki histopatolojik özellikler ve tanı raporları kolesterolozis varlığı yönünden incelenmiştir. Bulgular: 118 olgudan 21'inde (% 11,6) kolesterolozis varlığı saptanmıştır. Kolesterolozisli olguların hepsi kadın hasta olup yaşları 37-75 arasında değişmektedir. Ortalama yaş 56,4'tür (median: 60). 11 olguda (% 5,8) kolesterolozis ve kronik taşlı kolesistit; 8 olguda (% 4,3) kolesterolozis ve kolelityazis birlikteliği gözlenmiş, ilginç olarak 2 olguda (% 1,5) ise histopatolojik olarak yalnı z kolesterolozis tanısı verildiği dikkati çekmiştir. Sonuç: Literatürde de kolesterolozisin nadiren klinik semptomlara neden olabileceği, kolesistografik ve ultrasonografik olarak anomali tespit edilemeyen biliyer sistem rahatsızlığı düşünülen hastalarda kolesterolozis olasılığının düşünülmesi gerektiği vurgulanmaktadır. Kolesterolozis saptanması durumunda, gözlenen semptomlara göre klinik takip veya konservatif destek tedavisi gerekliliği, biliyer kolik episodlarının gözlendiği pür kolesterolozis olgularında ise kolesistektomi uygulanabileceği belirtilmektedir.

Anahtar Kelimeler

• Kolesterolozis, safra kesesi

Kaynakça

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