A Case of Cholesterol Hepatolithiasis with Multiple Cholesterin Granulomas

Nobuhiko Ueda, Ichiro Konishi, Yutaka Yoshimitsu, Nagayoshi Ohta, Naotaka Kadoya, Hisashi Hirosawa, Ryohei Izumi, Teisuke Hirono

Department of Surgery, Toyama City Hospital

A case of cholesterol hepatolithiasis with multiple cholesterin granulomas is reported. A 68-year-old man was operated on under the diagnosis of choledocholithiasis and hepatolithiasis limited to the lateral segment. Two of the choledocholiths were mixed stones. The mixed stones were compacted in the bile duct branches of B2 and B3 in the resected specimen of the lateral segment. Multiple small nodular lesions which were fused were seen in the parenchyma of the liver near the resected side. Pathologicaly, cholesterin crystals were found in the bile ducts containing stones, and cholesterin granulomas were found around the bile ducts. The small nodular lesions consisted of severe chronic inflammation with fibrosis containing multiple cholesterin crystals and cholesterin granulomas. The speculated etiology was that the lesions were formed as a result of repair of severe frequent cholangitis in the lateral segment due to the bile duct stones with the destructin of small bile ducts, scattering the cholesterin crystals in the bile juice. Severe dysplasia of the epithelium was also seen in part of the septal bile duct.

Key words
cholesterol hepatolithiasis, cholesterin granuloma, dysplasia of the bile duct epithelium

Reprint requests
Nobuhiko Ueda Department of Surgery, Toyama City Hospital
292 Imaizumi, Toyama, 939 JAPAN

Accepted
March 6, 1996

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