## Core Concept
Pigmented stones, primarily composed of bilirubin, are a type of gallstone commonly associated with hemolytic disorders. These stones are usually black or brown in color and are formed in the gallbladder. The formation of pigmented stones is linked to an increased bilirubin load in the bile, often due to conditions like sickle cell disease or other hemolytic anemias.

## Why the Correct Answer is Right
The correct answer, which is not specified here, would relate to a characteristic or condition not associated with pigmented stones. Typically, pigmented stones are associated with conditions that increase bilirubin production, such as hemolytic diseases. They are also more common in patients with cirrhosis and in those with a history of ileal disease or resection, which can affect bile salt circulation.

## Why Each Wrong Option is Incorrect
- **Option A:** Without the specific details of option A, we can infer that if it's related to a condition or characteristic commonly associated with pigmented stones (like being composed of bilirubin, associated with hemolytic disorders, or more common in certain patient populations), it would be a true statement.
- **Option B:** Similarly, if option B describes a feature or condition related to pigmented stones, such as their color, composition, or associated diseases, and it's accurate, then it's not the correct answer to the question about which statement is not true.
- **Option C:** This option would also be incorrect if it accurately describes a property or clinical correlation of pigmented stones.
- **Option D:** Given as the correct answer, this implies that option D describes something not true about pigmented stones.

## Clinical Pearl / High-Yield Fact
A key point to remember is that pigmented stones are often seen in patients with **hemolytic diseases** (like sickle cell anemia) and **cirrhosis**. These stones are usually **black** in color and are formed from **bilirubin**. A classic clinical scenario for pigmented stones includes a patient with a history of chronic hemolysis presenting with gallstones.

## Correct Answer: D.