Differential Diagnosis and Treatment Options for Xanthogranulomatous Cholecystitis

Abstract

Objective To describe the differential diagnosis and treatment options for xanthogranulomatous cholecystitis (XGC), the presentations and management of 68 patients were described. Subjects and Methods Demographical and clinical data from 68 cases of XGC treated between January 2004 and January 2010 were analyzed. Clinical characteristics, radiological and surgical findings, histopathological features and postoperative recoveries were recorded. Clinical features of laparoscopic cholecystectomy versus open surgery and XGC versus gallbladder (GB) cancer were compared. Results The CA19-9 levels of XGC and coexisting GB cancer were significantly different (p = 0.0034). In radiological findings, focal thickening of the GB wall was more frequent in coexisting GB cancer, early enhancement of the GB was observed more often in coexisting GB cancer, and lymph node enlargement was seen more often in coexisting GB cancer (p < 0.05). There were also significant differences between laparoscopic and open surgery for CA19-9, intramural hypoattenuated nodule, pericholecystic invasion, lymph node enlargement and maximum thickness, focal thickening, heterogeneous enhancement and early enhancement of the GB wall (p < 0.05). These findings were confirmed by multivariate analysis. Conclusions Ultrasound, computed tomography scan and intraoperative frozen section were the helpful modalities for XGC diagnosis. CA19-9 (>37 kU/l), pericholecystic invasion, lymph node enlargement (>10 mm), and focal thickening and early enhancement of the GB wall were the criteria for open surgery. In some selected cases, laparoscopic cholecystectomy was preferable.

Xanthogranulomatous Cholecystitis: Analysis of 108 Patients

“…Patients may have postoperative complications such as biliary injury, bile leakage, bleeding, and minor or major surgical site infections [4,5]. In our series, postoperative complications were seen in 10 patients (9.25 %).…”

“…Acute inflammation is followed by a granulomatous reaction and a cellular type of immune response [2][3][4]. Inflammatory process creates a macroscopic thickening of the gallbladder wall that closely resembles carcinoma formation and causes a fibrous reaction and scar formation which is responsible for the gross adhesions to surrounding tissues rendering surgical dissection to be significantly difficult [4,5]. This retrospective study aims to evaluate the clinical and radiological findings and surgical procedures and their effects on patients with XGC who were treated in our department in the last 11 years.…”

Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome: A case report

“…Pre-operative imaging often cannot definitively differentiate between these conditions as they share similar features including diffuse gallbladder wall thickening, hypoattenuated gallbladder nodules, invasion through cystic plate and portal lymphadenopathy. XGC therefore often requires pre-or-intra-operative frozen section to differentiate it from malignancy [ 6 ]. Studies suggest that 9.1%–32.5% of XGC also have concomitant MS [ 1 , [7] , [8] , [9] ].…”

How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

“…Lee et al [ 58 ] reported that non-focal wall thickening is a statistically common finding for XGC compared to GBC ( p < 0.001). Cui et al [ 59 ] reported that focal thickening of the GB wall was more frequent in XGC patients concomitant with GBC than those without GBC ( p = 0.0117).…”