A clinicopathologic study of primary cholesterol hepatolithiasis

We conducted the present study in order to clarify the clinicopathologic features of primary cholesterol hepatolithiasis and compare them with those in primary calcium bilirubinate hepatolithiasis.

We reviewed the clinicopathologic features of 24 patients with primary cholesterol hepatolithiasis. The clinical symptoms were mild, and the median duration of symptoms was 5 years.

In 22 patients complete stone clearance was obtained using percutaneous cholangioscopic lithotomy, partial hepatectomy, or their combination. The patients showed excellent clinical outcome (median follow-up period, 6 years) despite the absence of bilioenteric drainage. Stones have recurred in 4 patients, who remain asymptomatic. The histopathologic findings in 7 hepatectomized patients were compared with those in 7 patents with calcium bilirubinate hepatolithiasis. The inflammatory changes around the stone-containing duct, i.e., wall thickening, fibrosis, sludge formation, and glandular hyperplasia, were significantly milder in the cholesterol hepatolithiasis patients (p < 0.01 or p < 0.05).

These clinical and histopathologic findings indicate that primary cholesterol hepatolithiasis should be regarded as a different clinical entity from calcium bilirubinate hepatolithiasis which has a close relationship with bile stasis and bacterial infection as etiological factors.