Gallbladder & extrahepatic bile ducts

Gallbladder nonneoplastic

Cholesterol polyp


Editorial Board Member: Kimberley J. Evason, M.D., Ph.D.
Deputy Editor-in-Chief: Aaron R. Huber, D.O.
Reem Hamasha, M.D.
Raul S. Gonzalez, M.D.

Last author update: 28 July 2023
Last staff update: 28 July 2023

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PubMed Search: Cholesterol polyp

Reem Hamasha, M.D.
Raul S. Gonzalez, M.D.
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Cite this page: Hamasha R, Gonzalez RS. Cholesterol polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladdercholesterolpolyp.html. Accessed February 22nd, 2024.
Definition / general
Essential features
  • Polypoid variant of cholesterolosis
  • Cauliflower-like architecture with core of foamy lipid laden macrophages
  • Benign
ICD coding
  • ICD-10: K82.4 - cholesterolosis of gallbladder
  • ICD-11: DC10.3 - polyp of gallbladder
Epidemiology
Sites
  • Almost always arises in gallbladder
  • Possible in the common bile duct but very rare
Pathophysiology
Clinical features
  • Most are asymptomatic
  • May detach and behave like gallstones, causing biliary colic, obstruction, nausea, vomiting and rarely pancreatitis (N Am J Med Sci 2012;4:203)
Diagnosis
  • Incidental finding during abdominal ultrasound or on histopathologic examination following cholecystectomy
  • Definitive diagnosis requires microscopic examination (J Ultrasound 2021;24:131)
Laboratory
Radiology description
  • Usually multiple, pedunculated, small (< 1 cm) (J Ultrasound 2021;24:131)
  • Transabdominal ultrasound
    • Homogeneous, slightly more hyperechoic than liver parenchyma
    • Immobile / fixed despite positional change
    • Posterior acoustic shadowing is absent
Radiology images

Images hosted on other servers:
Hyperechoic homogeneous pedunculated polyps

Hyperechoic homogeneous pedunculated polyps

Prognostic factors
Case reports
Treatment
  • Asymptomatic polyps diagnosed incidentally can be managed by clinical follow up
  • If symptomatic, cholecystectomy
Gross description
Gross images

Images hosted on other servers:

Multiple yellow polyps

Microscopic (histologic) description
  • Cauliflower-like architecture is a distinctive / pathognomonic feature present in all cases and is generally not seen in other polyps
  • Connected to the gallbladder via very thin stalks; hence, they may detach from the surface
  • Foamy lipid laden macrophages generally make up the wide and edematous core of the polyp
    • 15% of cholesterol polyps may lack these lipid laden macrophages
  • Lined by a single layer of normal gallbladder epithelium
  • No epithelial elements in the core of the polyp and no dysplasia
  • Cholesterol polyps can be found in gallbladders devoid of any significant chronic changes (Am J Surg Pathol 2020;44:467)
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D., Andrey Bychkov, M.D., Ph.D. and Jijgee Munkhdelger, M.D., Ph.D.
Lipid laden macrophages

Lipid laden macrophages

Normal lining epithelium

Normal lining epithelium

Cauliflower-like architecture Cauliflower-like architecture

Cauliflower-like architecture

Lipid laden macrophages

Lipid laden macrophages


Foamy lipid laden macrophages

Foamy lipid laden macrophages

Polypoid lesion

Polypoid lesion

Stromal macrophages

Stromal macrophages

Lipid laden macrophages

Lipid laden macrophages

Sample pathology report
  • Gallbladder, cholecystectomy:
    • Cholesterol polyps (see comment)
    • Comment: Multiple yellowish round polyps are present in the body of the gallbladder, with the largest measuring 0.5 cm.
Differential diagnosis
Board review style question #1

A gallbladder resection specimen is found to contain a polyp with the histologic appearance shown above. What is the diagnosis?

  1. Adenomyomatosis
  2. Cholesterol polyp
  3. Hyperplastic polyp
  4. Inflammatory polyp
  5. Intracholecystic papillary neoplasm
Board review style answer #1
B. Cholesterol polyp. Cholesterol polyps have cauliflower-like architecture and are made of foamy lipid laden macrophages (both features seen in the image provided above). Answer E is incorrect because the polyp lining epithelium is normal biliary epithelium unlike in intracholecystic papillary neoplasms. Answer D is incorrect because the body of the polyp does not show inflammatory cells as in inflammatory polyps. Answer A is incorrect because the body of the polyp does not show hyperplastic smooth muscle as in adenomyomatosis. Answer C is incorrect because the polyp does not show hyperplastic gallbladder epithelium with elongated villi as in hyperplastic polyps.

Comment Here

Reference: Cholesterol polyp
Board review style question #2
Which of the following is a gross feature of cholesterol polyps of the gallbladder?

  1. Most are > 1 cm
  2. Most are sessile
  3. The surface exhibits a gritty texture
  4. They are usually solitary
  5. They exhibit a yellowish color
Board review style answer #2
E. They exhibit a yellowish color. Answer C is incorrect because cholesterol polyps have a smooth yellowish surface. Answer B is incorrect because most are pedunculated. Answer A is incorrect because most are < 1 cm. Answer D is incorrect because multiple / multifocal cholesterol polyps often coexist.

Comment Here

Reference: Cholesterol polyp
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