J.Jpn. Surg. Soc.. 60(14): 2091-2108, 1960

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STUDIES ON CHOLELITHIASIS Ⅱ. MICROSCOPIC STUDIES OF GALL-STONES

The author made microscopic observation on 23 cholesterol calculi, 3 mixed stones and 24 bilirubin calculi, all obtained by surgical operations in Matsukura Surgical Clinic, Nippon Medical School. With these materials the pathogenesis, formation and secondarg changes of gallstones (esp. spontaneous dissolution phenomen of the gallstone in vivo) were investigated, and, at the same time, these calculi were chemically analyzed and their correlation with clinical findings was investigated. The resuits obtained are as follows :
(1) Cholesterol stones were found to be classified into the 4 varieties, nameIy, radiating needles, radiating plaques, multinuclear clusters and clustered plaques.
(2) In pure cholesterol concretion, the process of crystallization is presumed to take place outward from the center as judged from the direction of extension of crystals. The speed of this crystal formation is generally considered to be rapid from the mineralogical standpoint, This is also substantiated clinically by the relatively short course of the disease, since the time elapsing from the onset of symptoms to the operative intervention is extremely short.
(3) The author found as instance of mixed calculus in which a daughter stone with a nucleus quite distinct from the plaque formation in the bilirubin lime portion of the external layer. There was also another case of mixed calculus in which an inner cholesterol stone was formed with a nucleus resulting from the union of two stones.
(4) Since cholesterol lime gall-stone formed with a central space is a multinuclear cluster, it is susceptible to denaturation and is believed to be produced by secondary dehydration.
(5) The great majority of bilirubin lime gall-stones presents a plaque structure and the plaque may be characterized by a concentric circular conformity, an irregular unconformity or a dysconformity, wave-shaped, interrupted wave-shaped, and indistinct plaque-like varieties.
(6) Of these varieties in plaque formation, the author discovered a spotnaneous litholytic phenomenon in 5 instances of irregular plaque stones.
(7) In regard to the relation of clinical symptoms to the microscopic findings obtained by the author, the most severe clinical manifectations are associated with bilirubin lime concretion occurring in the commom bile duct presenting a wave-shaped plaque formation, while the mildest symptome is seen with stones in radiating needles formed within the gall-bladder.
(Author's abstract)

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