CHOLESTEROL CRYSTAL EMBOLIZATION IN THE NETHERLANDS - A REVIEW OF 842CASES FILED IN THE DUTCH NATIONAL PATHOLOGY INFORMATION-SYSTEM FROM 1973 THROUGH 1994

Objective: To clarify the incidence and clinical features of cholester ol crystal embolization (CCE). Methods: Analysis of the relevant data of 842 diagnosed cases of CCE filed in the Dutch National Pathology In formation System from 1973 through 1994. Results: No report of CCE was recorded from 1973 through 1979. Since then, its incidence rose from 0.9 case per million population in 1980 to 6.0 cases per million popul ation in 1985, but stabilized thereafter. Among autopsy reports, the r elative percentage of CCE was similar over the years, with 0.35% in 19 82 and 0.30% in 1994 (mean, 0.31%; range, 0.20% to 0.42%). Nine patien ts in whom CCE was found in their renal transplant were excluded from the study. Thus, among a total of 833 elderly (mean age, 72.1 years), predominantly male (73.9%) patients, 1066 CCE sites were found in 323 biopsy reports, 264 resection reports, and 287 autopsy reports. Conclu sions: In the Dutch population, CCE is reported steadily, with an aver age frequency of 6.2 cases per million population per pear since 1985. It occurs predominantly in elderly men with a history of atherosclero tic disease and hypertension. Symptoms may be absent, go unrecognized, or mimic other disease processes. It can also be a coincidental findi ng. The primary CCE site is the kidney, followed by the skin and the g astrointestinal tract.