Cholesterol crystal morphology in acalculous gallbladder disease

Area of Science:

• Gastroenterology
• Hepatobiliary Science
• Medical Microscopy

Background:

• Biliary crystal morphology is well-documented in gallstone disease.
• Most bile microscopy occurs in patients with acalculous gallbladder disease, a condition with less defined crystal morphology.
• This study investigates biliary crystal morphology in acalculous gallbladder disease.

Purpose of the Study:

• To investigate and describe the morphology of biliary crystals in patients with acalculous gallbladder disease.
• To compare crystal morphology in patients with and without gallstones.
• To determine if bile aspiration affects crystal morphology.

Main Methods:

• Bile samples were collected from fresh cholecystectomy specimens.
• Polarizing microscopy was used to examine bile from patients with acalculous and calculous gallbladder disease.
• Microscopy slides were prepared by direct bile contact and bile aspiration via a 5-French cannula.

Main Results:

• Needle-like cholesterol crystals were predominant in patients without gallstones (acalculous gallbladder disease).
• Plate-like and dot-like crystals were more common in patients with gallstones.
• All three crystal morphologies (needles, dots, plates) were observed in most patients.
• Bile aspiration did not alter crystal morphology.

Conclusions:

• Birefringent needles and dots in bile microscopy should be identified as cholesterol crystals.
• These cholesterol crystal morphologies can be prevalent in patients diagnosed with acalculous gallbladder disease.