J Korean Surg Soc.  2009 Jun;76(6):371-377. 10.4174/jkss.2009.76.6.371.

Xanthogranulomatous Cholecystitis: A Retrospective Analysis of 36 Cases

• Seo SH
• Park JI
• Kim JS
• Kim KH
• Choi CS
• Choi YK

• KMID: 1464953
• DOI: http://doi.org/10.4174/jkss.2009.76.6.371

Abstract

PURPOSE: Xanthogranulomatous cholecystitis (XGC) is an uncommon, benign destructive and chronic inflammatory disease which is characterized by a marked proliferative fibrosis within the gallbladder wall. XGC occasionally involves adjacent organs and mimicking an advanced gallbladder carcinoma (GBC). The purpose of this study was to review the clinical manifestations, radiologic and pathologic findings of XGC and to investigate an appropriate treatment plan for patients with XGC.
METHODS
We retrospectively analyzed the clinical data of 36 patients with a pathologic diagnosis of XGC operated between January 2003 and June 2008.
RESULTS
The most frequent clinical symptom was biliary colic (88.8%). Radiologic studies revealed cholelithiasis in 30 patients (83.3%), thickening of gallbladder wall in 24 patients (66.6%), suspicious cancer in 11 patients (30.5%) and Mirizzi syndrome in 3 patients (8.3%). Laparoscopic cholecystectomy was planned in 18 patients but converted to open surgery in 9 patients. Open cholecystectomy was planned and performed in 13 patients including 8 cases of T-tube choledocholithotomy and 1 case of excision of a cholecystoduodenal fistula. Extended cholecystectomy was performed on 3 patients. GBC was suspected before operation in 11 patients. Of these, frozen-section biopsy was performed in 6 and found to be malignant in 1 patient. One patient who had no operative suspicion of malignancy turned out to have GBC at final histology.
CONCLUSION
XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis can be obtained by pathologic examination only. If there is an intraoperative suspicion of GBC, frozen-section biopsy will help to decide the appropriate mode of operation.

Keyword

Xanthogranulomatous cholecystitis; Gallbladder cancer; Cholecystectomy

MeSH Terms

Biopsy
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis
Cholelithiasis
Colic
Fibrosis
Gallbladder
Gallbladder Neoplasms
Granuloma
Humans
Intestinal Fistula
Mirizzi Syndrome
Retrospective Studies
Xanthomatosis
Cholecystitis
Granuloma
Xanthomatosis

Figure

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  Fig. 1 Several computed tomographic findings in patients with xanthogranulomatous cholecystitis. (A) CT scan shows focal gallbladder wall thickening and mass like lesion. This patient was diagnosed with gallbladder carcinoma preoperatively. (B) CT scan shows diffuse gallbladder wall thickening with multiple intramural hypoattenuated nodules. (C) CT scan shows irregular gallbladder wall thickening with hyperemic change of gallbladder bed, and pericholecytic infiltration.

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  Fig. 2 Microscopic finding of xanthogranulomatous cholecystitis Xanthogranulomatous inflammation of the gallbladder wall, characterized by histocytes containing neutral fat and lipofucin pigment (H&E, ×200).

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