Cholesterolosis of the common bile duct with anomalous arrangement of the pancreaticobiliary ductal system

 CommentarySo many topics to talk about and so little space. Let's select one: cholesterolosis. This disorder is one of the so-called hyperplastic cholecystoses (the other being adenomyosis) and results when cholesterol esters are deposited in macrophages (“foam cells”) within the mucosa and lamina propria of the gallbladder; an increased serum cholesterol level does not predispose to cholesterolosis. The diffuse form of cholesterolosis causes the mucosa of the gallbladder to exhibit a yellow (lipid) stippling resembling the well-known and delicious fragarian fruit; hence, the term “strawberry gall bladder.” In its localized form, cholesterolosis may present as multiple, polyp-like growths. Cholesterolosis of the CBD is a much rarer occurrence and one that reminded the authors of another fruit, the muskmelon. Muskmelon (Cucumis melo) is a species of melon that originated in Persia and has been developed into many varieties, including the smooth-skinned types (eg, honeydew) and various cultivars known as cantaloupes, the rough skin of which resembles the mucosal aspect of this patent's CBD. Cholesterolosis, in contrast to its 2 associated anomalies in this particular common duct (ie, AAPB and CCC), is not associated with an increased risk of malignancy but with 2 premalignant conditions of the CBD. I would prefer the duct to reside in a jar of formalin rather than allow it continued in vitro exposure to a stream of bile. As for the markedly elevated biliary amylase level, pancreatic enzymes have been postulated to play a causative role in the development of choledochal cysts, are commonly observed in CCC with AAPD, and can be considered a surrogate marker of pancreaticobiliary reflux.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(07)03337-8

doi:10.1016/j.gie.2007.12.031

© 2008 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.