Zur Morphologie und Histochemie der Steingallenblase des Menschen

Intracellular liposomes and cholesterol deposits in chronic cholecystitis and biliary sludge

Ultrastructural study of a group of selected specimens of chronic cholecystitic gallbladders reveals cholecystocyte changes characterized by abraded and altered microvilli accompanied by mitochondrial damages in the apical regions as well as mucus accumulation with aggregated, angulated lysosomes and heterogeneous liposomes. These liposomes contain needle-like crystals, probably rich in cholesterol. Many fragments of cholecystocystes and damaged organelles or contents can be found in the biliary sludge. These data support previous reports suggesting that there is an association between cholecystitis and the presence of cholelithiasis, subsequent to the production of altered bile. The present data suggest that disintegrating, sloughed cholecystocyte contents also contribute to the bile sludge, a complex milieu enriched by lipids, cholesterol deposits, altered mucus due in part to changes in expression of apomucins. The instability of prolonged storage of such modified bile, caused and/or accompanied by other associated metabolic defects, including gallbladder sluggishness, would favor the nucleation and the enlargement of gallstones. Based on the aforementioned data, a comprehensive sequence for cholecystocyte ultrastructural alterations and pathologies is proposed, as a result of chronic cholecystitis.

Characterization of glycoproteins in the epithelial cells of human and other mammalian gallbladder. A review

The mammalian gallbladder mucosa is lined by a simple columnar epithelium. Typical surface epithelial cells (principal cells) contain short microvilli, secretory granules, dense bodies, mitochondria and Golgi apparatus. Dense bodies are thought to be lysosomes. Secretory granules contain mucous glycoproteins which are released to the lumen by exocytosis. Oligosaccharide side chains of mucous glycoproteins may provide a favorable environment for nucleation of cholesterol in gallstone formation; therefore they have been studied during the past decades. Histochemical techniques allow the in situ identification of carbohydrates at both the cellular and subcellular levels. The oligosaccharide chains of principal cell mucous glycoproteins have been studied by classical histochemical techniques (PAS, alcian blue, HID, etc). These techniques indicate that mammalian gallbladder mucous glycoproteins are heavily sulphated, whereas sialic acid residues are scarce. Neutral mucins have not been described in the mammalian gallbladder. Electron microscopic studies have located the oligosaccharide chains in secretory granules and Golgi apparatus. More recently, lectins (molecules which specifically recognize and bind with different saccharides or saccharide sequences) have been applied for the intracellular localization of carbohydrate residues. Lectin histochemistry has detected fucose, galactose, N-acetylglucosamine, N-acetylgalactosamine and N-acetylneuraminic acid residues in mucous granules, Golgi apparatus and apical membrane of human principal cells. Mannose residues were observed only in dense bodies. The combined use of deglycosylation procedures and lectin histochemistry has revealed a variety of terminal sequences in oligosaccharide chains of gallbladder mucous glycoproteins: Neu5Ac(alpha 2-3)Gal(beta 1-3)GalNAc, Neu5Ac(alpha 2-3)Gal(beta 1-4)GlcNAc and Gal(beta 1-4)GlcNAc. This technology also suggested the occurrence of N-linked oligosaccharides in the dense bodies of principal cells. Mucous granules mainly contained mucin-type O-linked oligosaccharides although some N-linked chains have also been detected. Gallstone formation is probably a complex process depending on multiple factors. Mucous glycoproteins are one of the factors involved in this process. Histochemical methods offer an excellent research tool for the characterization of glycoproteins in the epithelial cells of the gallbladder, thus contributing to the elucidation of the pathophysiology of gallstone formation.

Ultrastructural aspects of human gallbladder epithelial cells in cholelithiasis: production of anionic mucus

The surface epithelium of 28 gallbladders removed during elective cholecystectomies and pathology collection was studied ultrastructurally. Focusing on 10 of the 28 cases that were diagnosed as cholecystitis, we found that the epithelium displayed numerous apical mucous granules and bulging apical apices. Mucous granule changes included 1) hyperproduction of secretory granules of neutral type containing an electron-dense proteinaceous spherule, similar to that described in other mucus-producing glands of the digestive system, and 2) production of anionic, osmiophilic secretory mucus. Other alterations of the surface epithelial cells included the production of bizarre surface appendages resembling primitive cilia without axoneme and epithelial excrescences.

Comparative morphology of the gallbladder and biliary tract in vertebrates: variation in structure, homology in function and gallstones

A review of investigations on the morphology of the gallbladder and biliary tract in fish, reptiles, amphibians, birds, and mammals was performed. Scanning electron microscopy, transmission electron microscopy, and light microscopy observations by the authors were also included. Variations in the presence or absence of a gallbladder, surface epithelium of the gallbladder, and differences in the morphology of the biliary tract in vertebrates were reported. Many differences were diet-related. Despite some dissimilarities observed, analogous functioning of the biliary system was accomplished by its various components, with the biliary ducts performing the function of the gallbladder when this organ was absent. In addition, the occurrence of peculiar parasitism and gallstones among some cases of vertebrates, including humans, was presented.

Histochemistry of mucosubstances in the gallbladder epithelium of the chick embryo

Mucosubstances of epithelial cells of the chick embryo gallbladder were investigated by histochemical methods from days 12-21 of incubation (stages 38-46). On incubation day 14, only neutral mucins were detected; on day 15, neutral and sulfated mucosubstances were observed in the epithelial cells that invaginate the underlying mesenchyme. In the same sites, at day 16 of incubation, neutral, carboxylated and sulfated mucins were seen. From the 17th day of incubation until hatching, neutral, carboxylated and sulfated mucosubstances were present in the surface cells and in the cells lining the epithelial invaginations. During this period, the chemical characteristics of the secretory material are similar to those observed by Yamada and Hoshino (1972) in the fowl.

Lipid in the human gallbladder mucosa. A histochemical study by light and electron microscopy

The distribution of lipids in the epithelium of 70 gallbladders removed for cholecystitis was investigated histochemically. Lipid was demonstrated in 68 gallbladders--cholesterol and its esters, triglycerides, free fatty acids and phospholipids. Neutral lipid was found at the bases of epithelial cells in 90 per cent and at the apex in 10 per cent of the gallbladders. Phospholipid was shown at the apex of epithelial cells in 64 per cent of the gallbladders. Electron microscopy in 12 specimens revealed cholesterol in and between the epithelial cells and in the underlying connective tissue.

Gallbladder epithelial acid hydrolases in human cholecystitis

The lysosomal enzymes beta-glucuronidase and acid phosphatase were studied in 112 patients with cholecystitis. Acid phosphatase activity was generally lower in patients with cholesterol stones compared with cases with pigment stones. beta-glucuronidase activity was higher in acalculous cholecystitis than in any other group, a fact compatible with the concept that in lithiasis the enzyme is secreted into the bile and therefore may participate in nidus formation. Histochemistry at light microscopical level clearly demonstrates the lysosomal distribution of these enzymes and their presence in the macrophages infiltrating lamina propria in cholesterolosis. Electron histochemistry in 45 patients showed acid phosphatase activity in lysosomes and some in mucous droplets. Thiamine pyrophosphatase activity, a marker for the Golgi system, showed a close association with these mucous droplets. The secretion of mucus will be accompanied by a secretion of acid phosphatase, and by implication other acid hydrolases, into the bile.

Cholecystitis: a fine structural analysis

The epithelial cells from 40 gallbladders showing chronic cholecystitis and five with cholesterolosis were examined by electron microscopy. A number of features of non-specific cytological injury were noted some of which may have been related to the disease and others to anoxia. The basement membrane showed reduplication. Intraepithelial cells were identified as lymphocytes, polymorphonuclear leukocytes, macrophages and mast cells. Lipid droplets in the epithelial cells were found in 60 per cent. of the specimens.

Effects of lithogenic diets on mouse gallbladder epithelium. A histochemical, cytochemical and morphometric study

Mice fed a cholesterol-cholic acid-containing lithogenic diet developed gallstones within 2 months. The gallbladders were grossly distended and morphometric studies of the gallbladder revealed a significant epithelial hyperplasia after 2 weeks. Based on results obtained with histochemical techniques an increase of glycoproteins could be demonstrated in the principal cells of the invaginations and crypts in the gallbladder mucosa after 2 weeks. At the ultrastructural level the principal cells showed increased numbers of secretory granules and in crypts so-called gland cells with large amounts of secretory droplets appeared. There were numerous signs of excytotic release of cell secretory products during gallstone formation. The findings suggest an increased synthesis of glycoproteins in the gallbladder epithelium and an enhanced secretion prior to or concomitant with gallstone formation.

[The development of the guinea pig gallbladder epithelial cells. I. Light microscopical and carbohydrate-histochemical investigations (author's transl)]

The development of the guinea pig gallbladder epithelium was studied from the 19th day of intrauterine life to the 31st postnatal day by means of histological and histochemical staining reactions. At first, the epithelium is a columnar pseudostratified one. Its transformation into a simple columnar eptihelium is terminated by the 31st day of the intrauterine life. Then the epithelial cells become more columnar and their nuclei acquire a basal position. Somewhat later the epithelium invaginates the underlying mesenchyme. Up to the 57th day the epithelium contains much glycogen. Neutral and carboxylated mucosubstances are demonstrable after the 30th day. From the 48th day onwards sulphated mucosubstances can be visualized in some cells in the depth of the invaginations and from the 51st day in the epithelial cells of the gallbladder. "Light" mucoid cells appear first in the epithelium of day 58. After the 6th postnatal day the "light" cells are rarely seen in the invaginations. The development of the gallbladder epithelium is completed about the 10th postnatal day. The epithelial mucosubstances of the gallbladder of the adult animal could be classified as GC- mucins and S-mucinsA, 1.0 MgCl2.