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Table of Contents
Vol. 29, No. 3, 2012
Issue release date: August 2012
Dig Surg 2012;29:187–193
(DOI:10.1159/000336985)

Xanthogranulomatous Cholecystitis: Catching the Culprit – Clinical and Imaging Analysis

Jain S. · Saluja S.S. · Sharma A.K. · Sant H. · Mishra P.K.
Departments of aGastrointestinal Surgery and bRadiology, GB Pant Hospital, New Delhi, India

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Abstract

Background: Radiological and intraoperative findings of xanthogranulomatous cholecystitis (XGC) mimic carcinoma gallbladder (CaGB) leading to extended surgical resections and increased morbidity. We reviewed the clinical and CECT findings of histopathologically proven XGC and compared them with those of CaGB. Methods: The clinical and CECT findings from 22 patients with XGC were compared with 15 patients with CaGB manifesting as diffuse wall thickening. Results: GB wall thickness was similar in both groups (XGC 12.4 ± 3 mm, CaGB 13.9 ± 6.5 mm; p = 0.61). Intramural hypoattenuating nodules occupying >60% of the GB wall were suggestive of XGC, while the absence of nodules suggested CaGB (p = 0.017). The mucosal lining was intact and enhancing in XGC (20/22) and disrupted in CaGB (10/15; p = 0.001). Among adjacent organ infiltration, bile duct invasion resulting in obstruction was a significant finding in patients with CaGB (p = 0.04). Among XGC patients, 11 patients underwent radical cholecystectomy, 10 had open cholecystectomy and frozen section and 1 underwent bypass. Conclusions: Though there is an overlap between XGC and CaGB, the presence of intramural hypoattenuating nodules occupying >60% of the diffusely thickened GB wall with intact mucosal line and the absence of obstructive features suggest XGC. In the presence of such imaging features, frozen biopsy should be done before proceeding with mutilating radical surgery.



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References

  1. Christensen AH, Ishak KG: Benign tumours and pseudotumours of the gall bladder. Archives of Pathology 1970;90:423–432.
  2. Takahashi K, Oka K, Hakozaki H, Kojima M: Ceroid-like histiocytic granuloma of gall bladder. Acta Pathol Jpn 1976;26:25–46.
  3. Dixit V K, Prakash A, Gupta A, Pandey M, Gautam A, Kumar M, Shukla VKl: Xanthogranulomatous cholecystitis. Dig Dis Sci 1998;43:940–942.
  4. Chun KA, Ha HK, Yu ES. Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gall bladder carcinoma. Radiology 1997;203:93–97.
  5. Parra JA, Acinas O, Bueno J, Güezmes A, Fernández MA, Fariñas MC: Xanthogranulomatous cholecystitis clinical, sonographic, and CT findings in 26 patients. AJR 2000;174:979–983.
  6. Houston JP, Collins MC, Cameron I, Reed MW, Parsons MA, Roberts KM: Xanthogranulomatous cholecystitis. Br J Surg 1994;81:1030–1032.
  7. Cossi AF, Scholz FJ, Aretz T, Larsen CR: Computed tomography of xanthogranulomatous cholecystitis. Gastrointest Radiol 1987;12:154–155.
  8. Ruckert JC, Ruckert RI, Gellert K, Muller MJ: Surgery for carcinoma gall bladder. Hepatogastroenterology1996;43:527–533.
  9. Reed A, Ryan C, Schwartz SI: Xanthogranulomatous cholecystitis. J Am Coll Surg 1994;179:249–252.
  10. Uchiyama K, Ozawa S, Ueno M, Hayami S, Hirono S: Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma. J Hepatobiliary Pancreat Surg 2009;16:333–338.

    External Resources

  11. Goshima S, Change S, Wange JH, Kanematsub M, Bae KT, Federle MP: Xanthogranulomatous cholecystitis: diagnostic performance of CT to differentiate from gall bladder cancer. Eur J Radiol 2010;74:79–83.

    External Resources

  12. Shuto R, Kiyosue H, Komatsu E, Matsumoto S, Kawano K, Kondo Y, Yokoyama S, Mori H: CT and MR imaging findings of xanthogranulomatous cholecystitis-correlation with pathological findings. Eur Radiol 2004;14:440–446.

    External Resources

  13. Kim PN, Lee SH, Gong GY, Kim JG, Ha HK, Lee YJ, Lee MG, Auh YH: Xanthogranulomatous cholecystitis: radiological finding with histological correlation. AJR 1999;172; 949–953.
  14. Guzman-Valdivia G: Xanthogranulomatous cholecystitis. An experience of 15 years. World J Surg 2004;8:254–257.

    External Resources

  15. Yang T, Zhang BH, Zhang J, Zhang YJ Jiang XQ, Wu MCl: Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases. Hepatobiliary Pancreat Dis Int 2007;5:504–508.
  16. Spinelli A, Schumacher G, Pascher A, Lopez-Hanninen E, Al-Abadi H, Benckert C, Sauer IM, Pratschke J, Neumann UP, Jonas S, Langrehr JM, Neuhaus P: Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: a case report and review of literature. World J Gastroenterol 2006;12:2293–2296.

    External Resources

  17. Hijioka S, Mekky MA, Bhatia V Sawaki A, Mizuno N, Hara K, Hosoda W, Shimizu Y, Tamada K, Niwa Y, Yamao K: Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc 2010;72:622–627.

    External Resources

  18. Chang BJ, Kim SH, Park HY, Lim SW, Kim J, Lee KH, Lee KT, Rhee JC, Lim JH, Lee JK: Distinguishing xanthogranulomatous cholecystitis from the wall-thickening type of early-stage gallbladder cancer. Gut Liver 2010;4:518–523.

    External Resources



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