Skip to main content
SpringerLink
Log in

Diagnosis and Treatment of Xanthogranulomatous Cholecystitis: A Report of 39 Cases

  • Original Paper
  • Published:
Cell Biochemistry and Biophysics Aims and scope Submit manuscript

Abstract

This study focuses on providing diagnosis and treatment for xanthogranulomatous cholecystitis (XGC). Clinical data from 39 patients diagnosed with XGC by pathological examination between 2002 and 2010 were analyzed retrospectively. As a result, in this group of patients, the male to female ratio was 30:9 and the average age of XGC onset was 62.2 years. Clinical manifestation of the disease was similar to general cholecystitis and preoperative CT examination showed that there were only 4 XGC cases, while the others were possibly misdiagnosed. Intraoperative observations showed that all the patients had gallbladder wall thickening. This was associated with gallbladder stones in 37 patients (94.9 %), choledocholith in 11 patients (28.2 %), and Mirizzi syndrome in 5 patients (12.8 %). In this study, intraoperative frozen section pathology was conducted in 14 patients and no gallbladder cancer was found. Laparoscopic cholecystectomy was performed on 7 patients, of which two were transferred to laparotomy. Of the remaining 32 cases, 25 were subjected to open cholecystectomy, 3 to partial cholecystectomy, and 4 to the cholecystectomy and partial liver wedge resection. It was concluded that XGC is a unique type of cholecystitis with atypical clinical manifestations and is often difficult to diagnose preoperatively. Pathological examination is a key to diagnose XGC and cholecystectomy is the primary surgical treatment. In patients with choledochectasia or jaundice, for whom we cannot exclude calculus of common bile duct, common bile duct exploration should be considered. The prognosis of XGC appears to be good with the above approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McCoy, J. J., Jr, Vila, R., Petrossian, G., McCall, R. A., & Reddy, K. S. (1976). Xanthogranulomatous cholecystitis. Report of two cases. Journal of South Carolina Medical Association, 72, 78–79.

    Google Scholar 

  2. Kwon, A. H., Matsui, Y., & Uemura, Y. (2004). Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis. Journal of the American College of Surgeons, 199, 204–210.

    Article  PubMed  Google Scholar 

  3. Guzman-Valdivia, G. (2004). Xanthogranulomatous cholecystitis: 15 years’ experience. World Journal of Surgery, 28, 254–257.

    Article  PubMed  Google Scholar 

  4. Levy, A. D., Murakata, L. A., & Rohrmann, C. A., Jr. (2001). Gallbladder carcinoma: Radiologic–pathologic correlation. Radiographics, 21, 295–314. Questionnaire, 549-255.

    PubMed  CAS  Google Scholar 

  5. Guzman-Valdivia, G. (2005). Xanthogranulomatous cholecystitis in laparoscopic surgery. Journal of Gastrointestinal Surgery, 9, 494–497.

    Article  PubMed  Google Scholar 

  6. Casas, D., Perez-Andres, R., Jimenez, J. A., Mariscal, A., Cuadras, P., et al. (1996). Xanthogranulomatous cholecystitis: A radiological study of 12 cases and a review of the literature. Abdominal Imaging, 21, 456–460.

    Article  PubMed  CAS  Google Scholar 

  7. Hsu, C., Hurwitz, J. L., Schuss, A., & Katz, D. S. (2003). Radiology–pathology conference: Xanthogranulomatous cholecystitis. Clinical Imaging, 27, 421–425.

    Article  PubMed  Google Scholar 

  8. Parra, J. A., Acinas, O., Bueno, J., Guezmes, A., Fernandez, M. A., et al. (2000). Xanthogranulomatous cholecystitis: Clinical, sonographic, and CT findings in 26 patients. AJR. American Journal of Roentgenology, 174, 979–983.

    PubMed  CAS  Google Scholar 

  9. Uchiyama, K., Ozawa, S., Ueno, M., Hayami, S., Hirono, S., et al. (2009). Xanthogranulomatous cholecystitis: The use of preoperative CT findings to differentiate it from gallbladder carcinoma. Journal of Hepatobiliary Pancreatic Surgery, 16, 333–338.

    Article  PubMed  Google Scholar 

  10. Srinivas, G. N., Sinha, S., Ryley, N., & Houghton, P. W. (2007). Perfidious gallbladders—A diagnostic dilemma with xanthogranulomatous cholecystitis. Annals of the Royal College of Surgeons of England, 89, 168–172.

    Article  PubMed  Google Scholar 

  11. Wang, M., Zhang, T., Zang, L., Lu, A., Mao, Z., et al. (2009). Surgical treatment for xanthogranulomatous cholecystitis: A report of 74 cases. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 19, 231–233.

    Article  CAS  Google Scholar 

  12. Pinocy, J., Lange, A., Konig, C., Kaiserling, E., Becker, H. D., et al. (2003). Xanthogranulomatous cholecystitis resembling carcinoma with extensive tumorous infiltration of the liver and colon. Langenbecks Archives of Surgery, 388, 48–51.

    Google Scholar 

  13. Enomoto, T., Todoroki, T., Koike, N., Kawamoto, T., & Matsumoto, H. (2003). Xanthogranulomatous cholecystitis mimicking stage IV gallbladder cancer. Hepato-Gastroenterology, 50, 1255–1258.

    PubMed  Google Scholar 

  14. Yoshida, J., Chijiiwa, K., Shimura, H., Yamaguchi, K., Kinukawa, N., et al. (1997). Xanthogranulomatous cholecystitis versus gallbladder cancer: Clinical differentiating factors. American Surgeon, 63, 367–371.

    PubMed  CAS  Google Scholar 

  15. Shukla, V. K., Gurubachan, Sharma, D., Dixit, V. K., & Usha, (2006). Diagnostic value of serum CA242, CA 19–9, CA 15–3 and CA 125 in patients with carcinoma of the gallbladder. Tropical Gastroenterology, 27, 160–165.

    PubMed  Google Scholar 

  16. Adachi, Y., Iso, Y., Moriyama, M., Kasai, T., & Hashimoto, H. (1998). Increased serum CA19-9 in patients with xanthogranulomatous cholecystitis. Hepato-Gastroenterology, 45, 77–80.

    PubMed  CAS  Google Scholar 

  17. Kim, J. H., Jeong, I. H., Yoo, B. M., Kim, M. W., & Kim, W. H. (2009). Is xanthogranulomatous cholecystitis the most difficult for laparoscopic cholecystectomy? Hepato-Gastroenterology, 56, 597–601.

    PubMed  Google Scholar 

  18. Houston, J. P., Collins, M. C., Cameron, I., Reed, M. W., Parsons, M. A., et al. (1994). Xanthogranulomatous cholecystitis. British Journal of Surgery, 81, 1030–1032.

    Article  PubMed  CAS  Google Scholar 

  19. Kwon, A. H., & Sakaida, N. (2007). Simultaneous presence of xanthogranulomatous cholecystitis and gallbladder cancer. Journal of Gastroenterology, 42, 703–704.

    Article  PubMed  Google Scholar 

  20. Lopez, J. I., Elizalde, J. M., & Calvo, M. A. (1991). Xanthogranulomatous cholecystitis associated with gallbladder adenocarcinoma. A clinicopathological study of 5 cases. Tumori, 77, 358–360.

    PubMed  CAS  Google Scholar 

  21. Takada, M., Horita, Y., Okuda, S., Okumoto, S., Samizo, M., et al. (2002). Genetic analysis of xanthogranulomatous cholecystitis: Precancerous lesion of gallbladder cancer? Hepato-Gastroenterology, 49, 935–937.

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Key Sci-Tech Research Foundation of Fujian Province in China (No. 2009Y0021), and the Key Project of Fujian Medical University in China (No. 09ZD017).

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China

    Sheng-Hua Han & Yan-Ling Chen

  2. Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Research Center of Molecular Medicine, Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Yan-Ling Chen

Authors
  1. Sheng-Hua Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan-Ling Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yan-Ling Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Han, SH., Chen, YL. Diagnosis and Treatment of Xanthogranulomatous Cholecystitis: A Report of 39 Cases. Cell Biochem Biophys 64, 131–135 (2012). https://doi.org/10.1007/s12013-012-9381-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12013-012-9381-y

Keywords

Search

Navigation