Korean J Hepatobiliary Pancreat Surg.  2006 Sep;10(3):7-13.

Xanthogranulomatous Cholecystitis: Clinical review of 14 cases

Affiliations
  • 1Department of Surgery, College of Medicine,Hallym University,Korea. jjy1030@hallym.ac.kr
  • 2Department of Radiology, College of Medicine,Hallym University,Korea.
  • 3Department of Pathology, College of Medicine,Hallym University,Korea.

Abstract

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings.
METHODS
We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed.
RESULTS
Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery.
CONCLUSIONS
Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.

Keyword

Xanthogranulomatous cholecystitis; Mirizzi syndrome

MeSH Terms

Biopsy
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis*
Cholecystitis, Acute
Cholelithiasis
Conversion to Open Surgery
Diagnosis
Fibrosis
Gallbladder
Gallbladder Neoplasms
Humans
Mirizzi Syndrome
Retrospective Studies
Ultrasonography
Full Text Links
  • KJHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr