Histology and Explanation of Cholesterolosis (strawberry gallbladder)

Cholesterolosis of the gallbladder. (HE, ob x4)

Cholesterolosis of the gallbladder (detail of an enlarged mucosal fold). (HE, ob x10)

Cholesterolosis is an intracellular accumulation of lipids (cholesterol). When cholesterol is in excess in the bile, it passes into the lamina propria where is phagocitated by macrophages. These macrophages become larger and polygonal, with foamy cytoplasm and small, hyperchromatic, central nucleus (xantic cells). Aggregation of xantic cells may enlarge the mucosal folds, producing a polypoid appearance of the mucosal surface. At gross examination, these yellow micropolyps (1-2 mm) contrasts with the red aspect of the surrounding mucosa, hence the term "strawberry gallbladder".

Sometimes, cholesterolosis is associated with inflammation of the gallbladder (cholecystitis) or with gallstones (cholelithiasis).