Cholesterol Clefts — MFDS Part 1 MCQ
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Correct answer: D — Local crystallisation of cholesterol released from lipid-laden macrophages in chronically inflamed granulation tissue
The correct answer is D. In chronically inflamed radicular cyst walls, locally accumulated lipids are taken up by macrophages, producing foam cells. Breakdown of these lipid-laden macrophages releases cholesterol, which can concentrate and crystallise. The crystals dissolve during routine histological processing, leaving characteristic needle-shaped clefts surrounded by foreign-body giant cells. This is a local inflammatory process rather than direct deposition of dietary cholesterol. B therefore does not explain the local granulomatous reaction. Bacteria may cause secondary infection but do not produce these cholesterol clefts, excluding C. Viral inclusions have a different intracellular appearance, while dystrophic calcification produces basophilic mineral deposits rather than empty needle-shaped spaces, excluding D and E.
Reference: Yamamoto T et al. Basement membrane-type heparan sulfate proteoglycan (perlecan) and low-density lipoprotein (LDL) are co-localized in granulation tissues: a possible pathogenesis of cholesterol granulomas in jaw cysts. Journal of Oral Pathology & Medicine. 2004. https://pubmed.ncbi.nlm.nih.gov/15128060/