Xanthogranulomatous Cholecystitis Mimicking Carcinoma Gallbladder

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Abstract

Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and can mimic gallbladder carcinoma. Distinguishing XGC from gallbladder cancer preoperatively is challenging. We present a case of a 62-year-old male who presented with features of carcinoma gallbladder in the CECT abdomen and MRCP. Intraoperatively, there was a mass in the gallbladder and extension into the adjacent structures with involvement of the hepatic artery, 1 ^st part of the duodenum, portal vein, and hepatic flexure of the colon, and thus a palliative cholecystectomy was done. The histopathological report came out as XCG. The case aims to outline the clinical presentation of XGC and differentiate it from carcinoma gallbladder.

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Most cited references 24

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Xanthogranulomatous cholecystitis: 15 years' experience.

G Guzman (2004)

The demographic and clinical aspects of xanthogranulomatous cholecystitis (XGC) over a period of 15 years are reviewed. The review entailed examining 12,426 clinical files of patients who had undergone cholecystectomy, including 182 patients with a histopathologic diagnosis of XGC. Altogether, 1.46% of the cholecystectomies performed were done on patients with a diagnosis of XGC. XGC presented in patients over the age of 32, with a male/female ratio of 2:1. Thickening of the gallbladder wall, seen on ultrasonography and computed tomography scans, was demonstrated in 100% of the cases. A total of 17% of the cases presented in acute form. Obstructive jaundice was observed in 23% of the patients, 11 of which cases were associated with choledocholithiasis (30% of these patients had jaundice) and the rest with extrinsic obstruction of the bile tract (Mirizzi syndrome). XGC was associated with lithiasis in 85% of the cases. A malignant lesion was suspected during operation in 30% of the cases, requiring histopathologic examination during surgery. Carcinomatous lesions were found in 3% of the cases. Surgical difficulty was reported in 65% of the cases, resulting in the performance of partial cholecystectomy in 35%. XGC is an infrequent form of chronic inflammation of the gallbladder, the clinical presentation of which is similar to that of cholecystitis; given the thickening of the gallbladder wall, it makes cholecystectomy difficult. As XGC may resemble adenocarcinoma, differentiation is essential by means of intraoperative histologic examination to ensure optimal surgical treatment.

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Xanthogranulomatous cholecystitis: diagnostic performance of CT to differentiate from gallbladder cancer.

Satoshi Goshima, Samuel Chang, Jin Hong Wang … (2010)

To retrospectively evaluate CT findings of xanthogranulomatous cholecystitis (XGC) and to measure diagnostic performance for distinguishing it from gallbladder (GB) cancer. Our institutional review board approved this retrospective study. Three blinded radiologists, first independently and then in consensus, retrospectively evaluated postcontrast CT images of 35 patients with histopathologically proved XGC and GB cancer, all of whom subsequently had cholecystectomy. These included 18 patients with XGC (13 male, 5 female; age range, 35-84, mean 63 years) and 17 with GB cancer (6 male, 11 female; age range, 45-95, mean 69). Differences in CT findings between XGC and GB cancer and diagnostic performances for each CT finding were calculated. Sensitivity, specificity, and accuracy were calculated for each radiologist and observer performance was also determined by receiver-operating-characteristic curve analysis. Five CT findings showed significant differences between XGC and GB cancer. Sensitivity, specificity, and accuracy of each finding for the differentiation of XGC were 89%, 65%, 77% with diffuse GB wall thickening, 67%, 82%, 74% with a continuous mucosal line, 61%, 71%, 66% with intra-mural hypo-attenuated nodules, 72%, 77%, 74% with absence of macroscopic hepatic invasion, and 67%, 71%, 69% with absence of intra-hepatic bile duct dilatation, respectively. When at least three of these five CT findings were observed in combination, sensitivity, specificity, and accuracy were 83%, 100% and 91%, respectively. Sensitivities, specificities and Az values for the differentiation of XGC from GB cancer were 83%, 88%, 0.94 for reader 1, 78%, 88%, 0.93 for reader 2, and 78%, 82%, 0.84 for reader 3. The combination of three of the five CT findings that are common with XGC can provide excellent accuracy for the differentiation of XGC and GB cancer. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

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CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases.

Feng Zhao, Pu-Xuan Lu, Sen-Xiang Yan … (2013)

To study the CT and MR features of xanthogranulomatous cholecystitis (XGC).

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Author and article information

Contributors

Suraj Shrestha:

ORCID: https://orcid.org/0000-0001-6888-260X

Journal

Journal ID (nlm-ta): Case Reports Hepatol

Journal ID (iso-abbrev): Case Reports Hepatol

Journal ID (publisher-id): CRIHEP

Title: Case Reports in Hepatology

Publisher: Hindawi

ISSN (Print): 2090-6587

ISSN (Electronic): 2090-6595

Publication date Collection: 2023

Publication date (Electronic): 13 February 2023

Volume: 2023

Electronic Location Identifier: 2507130

Affiliations

¹Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal

²Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

³Department of Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal

⁴Kathmandu University School of Medical Sciences, Dhulikhel, Nepal

Author notes

Academic Editor: Sorabh Kapoor

Author information

Suraj Shrestha https://orcid.org/0000-0001-6888-260X

Pratima Gautam https://orcid.org/0000-0003-3939-3705

Article

DOI: 10.1155/2023/2507130

PMC ID: 9940947

PubMed ID: 36815138

SO-VID: fbcc01bc-d100-4ad8-bc81-ea2557f9a7ec

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 18 October 2022

Date revision received : 31 December 2022

Date accepted : 5 January 2023

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