Saito K, Nakanuma Y, Ohta T, Ueda N, Higashino Y, Yamamichi N, Kidani E
Second Department of Pathology, Kanazawa University School of Medicine, Japan.
J Clin Gastroenterol. 1990 Oct;12(5):585-90. doi: 10.1097/00004836-199010000-00020.
Three cases of pure cholesterol intrahepatic stones are compared morphologically to those of calcium bilirubinate stones. Cholesterol stones were found in the intrahepatic bile duct of the left lateral lobe in two cases and in both the left lateral and the right posterior lobe in one. Although the chronic inflammatory reaction and fibrous thickening of bile duct wall were similar in both types of hepatolithiasis, the proliferation of intrahepatic periductal glands and the production of mucin were rather mild, compared to that is the liner containing calcium bilirubinate stones. Multiple intramural cholesterol calculi and cholesterin granulomas (cholesterin crystals surrounded by foreign-body giant cells) were found within the cystically dilated small bile duct branches and/or conduits of periductal glands. The calculi and granulomas were characteristic for cholesterol hepatolithiasis. These findings suggest that the formation of the cholesterol stones differs from that of calcium bilirubinate stones; the perturbation of factors influencing cholesterol nucleation in the hepatic bile may be related to the changed microenvironment of the intrahepatic bile ducts, which is followed by the formation of cholesterol stones.
对三例纯胆固醇肝内结石与胆红素钙结石进行了形态学比较。两例患者的肝内胆管结石位于左外叶，一例患者的结石同时存在于左外叶和右后叶。虽然两种类型的肝内结石中胆管壁的慢性炎症反应和纤维增厚相似，但与含胆红素钙结石的内衬相比，肝内导管周围腺体的增生和粘蛋白的产生相当轻微。在囊性扩张的小胆管分支和/或导管周围腺体的导管内发现了多个壁内胆固醇结石和胆固醇肉芽肿（由异物巨细胞包围的胆固醇晶体）。这些结石和肉芽肿是胆固醇肝内结石的特征。这些发现表明，胆固醇结石的形成与胆红素钙结石不同；肝胆汁中影响胆固醇成核的因素的扰动可能与肝内胆管微环境的改变有关，随后形成胆固醇结石。
