Abstract
Background
Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, often misdiagnosed as gallbladder malignancy. The clinical and radiological features often mimic gallbladder carcinoma, and the association of this entity with carcinoma makes the treatment decision difficult.
Methods
An analysis of patients operated on between July 2017 and December 2018 with a preoperative diagnosis of gallbladder malignancy, which ultimately turned out to be XGC, was conducted, in an attempt to determine the clinical and radiological features which could facilitate the preoperative diagnosis of XGC.
Results
The study included 6 patients who underwent radical cholecystectomy with a preoperative diagnosis of gallbladder malignancy, which proved on histological examination to be XGC. All 6 patients presented with mild upper abdominal pain, discomfort, anorexia and weight loss. Three of them had been diagnosed with diabetes mellitus (DM) in the past. Contrast enhanced computed tomography (CECT) scan showed gallbladder wall thickening, liver infiltration and lymphadenopathy in all cases. The surgery performed was radical cholecystectomy alone in 3 cases, radical cholecystectomy with right hemicolectomy in 2, and radical cholecystectomy with right hemicolectomy along with a Whipple procedure in one case. The postoperative course was uneventful, only two patients developed superficial wound infection, with an average hospital stay of 8.1 days.
Conclusion
Differentiation of XGC from gallbladder carcinoma is difficult, and a definitive diagnosis necessitates histopathological examination. An accurate preoperative diagnosis requires an integrated review of the clinical and characteristic radiological features, the presence of which may help to avoid radical resection and avoidable morbidity in selected cases. Knowledge of the entity, a high degree of suspicion and involvement of an expert surgeon should provide the optimal management. An incorrect diagnosis may lead to inappropriate surgery - either over-treating it by performing a radical cholecystectomy for XGC or perfoming a simple laparoscopic cholecystectomy for a malignant lesion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Yang T, Zhang B, Zhang J, et al. Surgical treatment of xanthogranulomatous cholecystitis: Experience in 33 cases. Hepatobiliary Pancreat Dis Int 2007;6:504–8.
Uchiyama K, Ozawa S, Ueno M, et al. Xanthogranulomatous cholecystitis: The use of preoperative CT findings to differentiate it from gallbladder carcinoma. J Hepatobiliary Pancreat Surg 2009;16:333–8.
Levy A, Murakata L, Abbott R, et al. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: Radiologic-pathologic correlation. Radiographics 2002;22:387–413.
Krishnani N, Dhingra S, Kapoor S, et al. Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases. Acta Cytol 2007;51:37–41.
Spinelli A, Schumacher G, Pascher A, et al. Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature. World J Gastroenterol 2006;12:2293–6.
Srinivas GNS, Sinha S, Ryley N, et al. Perfidious gallbladders–a diagnostic dilemma with xanthogranulomatous cholecystitis. Ann R Coll Surg Engl 2007;89:168–72.
Kansakar PBS, Rodrigues G, Khan SA. Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution. Kathmandu Univ Med J 2008;6:472–5.
Goshima S, Chang S, Wang JH, et al. Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer. Eur J Radiol 2010;74:e79–e83.
Chang BJ, Kim SH, Park HY, et al. Distinguishing xanthogranulomatous cholecystitis from the wallthickening type of early-stage gallbladder cancer. Gut Liver 2010;4:518–23.
Rastogi A, Singh DK, Sakhuja P, et al. Florid xanthogranulomatous cholecystitis masquerading as invasive gallbladder cancer leading to extensive surgical resection. Indian J Pathol Microbiol 2010;53:144–7.
Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 1970;90:423–32.
McCoy JJ, Vila R, Petrossian G, et al. Xanthogranulomatous cholecystitis. Report of two cases. J S C Med Assoc 1976;72:78–9.
Hale MD, Roberts KJ, Hodson J, et al. Xanthogranulomatous cholecystitis: A European and global perspective. HPB 2014;16:448–58.
Krishna RP, Kumar A, Singh RK, et al. Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: Presentation and surgical management. J Gastrointest Surg 2008;12:836–41.
Priya TP, Kapoor VK, Krishnani N, et al. Fragile histidine triad (FHIT) gene and its association with p53 protein expression in the progression of gall bladder cancer. Cancer Invest 2009;27:764–73.
Zhang LF, Hou CS, Liu JY, et al. Strategies for diagnosis of xanthogranulomatous cholecystitis masquerading as gallbladder cancer. Chin Med J 2012;125:109–13.
Kishore R, Nundy S, Mehrotra S, et al. Strategies for differentiating gallbladder carcinoma from xanthogranulomatous cholecystitis–a tertiary care centre experience. Indian J Surg Oncol 2017;8:554–9.
Para JA, Acinas O, Bueno J, et al. Xanthogranulomatous cholecystitis: Clinical, sonographic and CT findings in 26 patients. Am J Roentgenol 2000;174:979–83.
Kim PN, Ha HK, Kim YH, et al. US findings of xanthogranulomatous cholecystitis. Clin Radiol 1998;53:290–2.
Shuto R, Kiyosue H, Komatsu E, et al. CT and MRI imaging findings of xanthogranulomatous cholecystitis: Correlation with pathologic findings. Eur Radiol 2004;14:440–6.
Hatakenaka M, Adachi T, Matsuyama A, et al. Xanthogranulomatous cholecystitis: Importance of chemical-shift gradientecho MR imaging. Eur Radiol 2003;13:2233–5.
Kang TW, Kim SH, Park HJ, et al. Differentiating xanthogranulomatous cholecystitis from wall thickening type of gall bladder cancer: Added value of diffusion weighted MRI. Clin Radiol 2013;68:992–1001.
Oe A, Kawabe J, Torii K, et al. Distinguishing benign from malignant gallbladder wall thickening using FDG-PET. Ann Nucl Med 2006;20:699–703.
Makino I, Yamaguchi T, Sato N, et al. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET. World J Gastroenterol 2009;15:3691–3.
Anderson CD, Rice MH, Pinson CW, et al. FDG-PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg 2004;8:90–7.
Koh T, Taniguchi H, Yamaguchi A, et al. Differential diagnosis of gallbladder cancer using positron emission tomography with FDG-PET. J Surg Oncol 2003;84:74–81.
Rodriguez-Fernandez A, Gomez-Rio M, Llamas-Elvira JM, et al. PET with 18-FDG for gallbladder cancer diagnosis. Am J Surg 2004;188:171–5.
Shukla S, Krishnani N, Jain M, et al. Xanthogranulomatous cholecystitis. Fine needle aspiration cytology in 17 cases. Acta Cytol 1997;41:413–8.
Hijioka S, Mekky MA, Bhatia V, et al. Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc 2010;72:622–7.
Rao RV, Kumar A, Sikora SS, et al. Xanthogranulomatous cholecystitis: Differentiation from associated gall bladder carcinoma. Trop Gastroenterol 2005;26:31–3.
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Godara, R., Kumar, R., Yadav, A. et al. Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Case Series and Literature Review. Hellenic J Surg 91, 96–101 (2019). https://doi.org/10.1007/s13126-019-0513-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13126-019-0513-3