In cholesterol cleft formation within atherosclerotic plaques, the liquefaction of the lipid core represents degradation of cholesterol esters by macrophage lipases. The histological appearance of cholesterol clefts after routine processing is:

• A Round uniform vacuoles (foamy cytoplasm of lipid-laden macrophages) without tissue reaction
• B Birefringent acicular crystals remaining intact under polarised light
• C Basophilic calcified deposits (dystrophic calcification) within necrotic cores
• D Needle-shaped empty spaces (ghosts of dissolved cholesterol crystals) surrounded by fibrotic tissue ✓

Explanation

Cholesterol crystals in atherosclerotic plaques are dissolved out by the alcohol and xylene used in routine histological processing, leaving behind characteristic empty needle-shaped clefts (cholesterol crystal ghosts) surrounded by fibrous or necrotic tissue. On polarised light in native frozen sections, the intact crystals appear birefringent; after standard paraffin processing only the empty clefts remain. Foam cells (lipid-laden macrophages) appear as cells with bubbly clear cytoplasm and are not the same as cholesterol clefts. Dystrophic calcification stains deeply basophilic on H&E.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.