[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Cell injury, adaptation and death](https://durgical.com/en/general-pathology/#a-injury) › Intracellular accumulations: cholesterol, proteins, hyaline, glycogen [General pathology](https://durgical.com/en/general-pathology/) · [Cell injury, adaptation and death](https://durgical.com/en/general-pathology/#a-injury) # Intracellular accumulations: cholesterol, proteins, hyaline, glycogen - Lesion Cells can fill up with fat, protein, glycogen or other material when they make too much, cannot process it or cannot get rid of it. Updated 2026-11-01 ## Key points - Four routes: too much normal substance, abnormal protein, enzyme defect, exogenous indigestible material. - Cholesterol: foam cells in atherosclerosis, xanthomas and cholesterolosis of the gallbladder. - Protein: reabsorption droplets in proximal tubules (proteinuria), Russell bodies in plasma cells, Mallory-Denk bodies in alcoholic hepatitis. - Hyaline is a descriptive term for any glassy pink material, inside cells or outside (hyaline arteriolosclerosis). - Glycogen: storage diseases and kidney tubules in poorly controlled diabetes; PAS-positive and removed by diastase. ## What it is Accumulations reflect an imbalance between production and removal. A normal substance may be made faster than it is used (fatty change), an abnormal one may be unable to fold or be degraded (alpha-1 antitrypsin), an enzyme defect may block breakdown (storage diseases), or an indigestible external material may be retained (carbon). Some are harmless, some injure the cell. ## Accumulations to recognise | Material | Where and why | How it looks | | --- | --- | --- | | Cholesterol (foam cells) | Macrophages and smooth muscle cells in atheromas take up oxidized LDL | Foamy cytoplasm; cholesterol clefts | | Protein reabsorption droplets | Proximal tubule cells reabsorb filtered protein in heavy proteinuria | Pink droplets in the tubular epithelium | | Russell bodies | Plasma cells full of immunoglobulin in the ER | Round eosinophilic inclusions | | Mallory-Denk bodies | Damaged keratin intermediate filaments in injured hepatocytes | Ropy eosinophilic clumps | | Alpha-1 antitrypsin globules | Misfolded Z protein retained in hepatocyte ER | PAS-positive, diastase-resistant globules | | Hyaline arteriolosclerosis | Plasma proteins leak into arteriole walls (hypertension, diabetes); extracellular | Homogeneous pink thickening | | Glycogen | Enzyme defects in storage diseases; hyperglycemia in tubules | Clear vacuoles; PAS-positive, diastase-sensitive | | Complex lipids | Lysosomal enzyme defects (Gaucher, Niemann-Pick, Tay-Sachs) | Distended macrophages or neurons | ## Clinical notes - Familial hypercholesterolemia causes tendon xanthomas and premature atherosclerosis from LDL receptor defects. - In von Gierke disease, glycogen fills hepatocytes and kidney cells, causing hepatomegaly and fasting hypoglycemia. ## In the lab - PAS stains glycogen, mucins and basement membranes; diastase digestion removes glycogen only. - Oil Red O on frozen tissue shows neutral lipids; Congo red identifies amyloid, an extracellular deposit. ## Memory aid Too much in, can’t fold, can’t break down, can’t digest: four doors through which a cell becomes a storeroom. ## Test yourself Think of the answer, then tap the question to see it. ## What are Russell bodies? Eosinophilic inclusions of immunoglobulin accumulated in the ER of plasma cells. ## How is glycogen distinguished from other PAS-positive material? Glycogen disappears after diastase digestion; alpha-1 antitrypsin globules and mucins remain. ## What are Mallory-Denk bodies made of and where are they seen? Aggregated keratin intermediate filaments in injured hepatocytes, typically in alcoholic or metabolic steatohepatitis. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/intracellular-accumulations-cholesterol-proteins-hyaline-glycogen/) ## Related - [Fatty change (steatosis)](https://durgical.com/en/general-pathology/fatty-change/) - [Pigments in tissue: lipofuscin, hemosiderin, melanin, bilirubin, carbon](https://durgical.com/en/general-pathology/pigments-in-tissue-lipofuscin-hemosiderin-melanin-bilirubin-carbon/) - [Endoplasmic reticulum stress and the unfolded protein response](https://durgical.com/en/general-pathology/endoplasmic-reticulum-stress-and-the-unfolded-protein-response/) - [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/) - [Special stains in diagnosis: Congo red, Prussian blue, PAS, Ziehl–Neelsen, Gram](https://durgical.com/en/general-pathology/special-stains-in-diagnosis-congo-red-prussian-blue-pas-ziehl-neelsen-gram/) ## Related conditions - [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - [Familial hypercholesterolemia](https://durgical.com/en/conditions/familial-hypercholesterolemia/) - [Von Gierke disease (glycogen storage disease type I)](https://durgical.com/en/conditions/von-gierke-disease/) - [Pompe disease (glycogen storage disease type II)](https://durgical.com/en/conditions/pompe-disease/) - [Niemann–Pick disease](https://durgical.com/en/conditions/niemann-pick-disease/) - [Gaucher disease](https://durgical.com/en/conditions/gaucher-disease/) - [Tay–Sachs disease](https://durgical.com/en/conditions/tay-sachs-disease/) - [α1-antitrypsin deficiency](https://durgical.com/en/conditions/1-antitrypsin-deficiency/) - [Alcoholic liver disease (biochemistry)](https://durgical.com/en/conditions/alcoholic-liver-disease/) - [Multiple myeloma](https://durgical.com/en/conditions/multiple-myeloma/) - [Nephrotic syndrome](https://durgical.com/en/conditions/nephrotic-syndrome/) - [Hypertensive nephrosclerosis](https://durgical.com/en/conditions/hypertensive-nephrosclerosis/) - [Diabetic kidney disease](https://durgical.com/en/conditions/diabetic-kidney-disease/) ## Elsewhere in DurgiPedia - [Lysosomal storage diseases](https://durgical.com/en/biochemistry/topics/lysosomal-storage-diseases/) - [Glycogen metabolism](https://durgical.com/en/biochemistry/pathways/glycogen-metabolism/) - [LDL receptor](https://durgical.com/en/biochemistry/enzymes/ldl-receptor/) - [Cholesterol](https://durgical.com/en/biochemistry/molecules/cholesterol/) - [α1-antitrypsin](https://durgical.com/en/biochemistry/enzymes/1-antitrypsin/) - [Microscopy and stains: H&E, PAS, trichrome, silver, immunohistochemistry](https://durgical.com/en/histology/microscopy-and-stains-h-y-e-pas-trichrome-silver-immunohistochemistry/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Glycogen storage disease type I: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/glycogen-storage-disease-type-i/) (MedlinePlus, US National Library of Medicine, 2024); [Familial hypercholesterolemia: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000392.htm) (MedlinePlus, US National Library of Medicine, 2024); [Alpha-1 antitrypsin deficiency: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/alpha-1-antitrypsin-deficiency/) (MedlinePlus, US National Library of Medicine, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/intracellular-accumulations-cholesterol-proteins-hyaline-glycogen/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/intracellular-accumulations-cholesterol-proteins-hyaline-glycogen/