Xanthogranulomatous cholecystitis: Diagnosis and management

Giudicelli, Xavier; Rode, Agnès; Bancel, Brigitte; Nguyễn, Anh Tuấn; Mabrut, Jean‐Yves

doi:10.1016/j.jviscsurg.2021.02.004

Cited by 9 publications

(19 citation statements)

References 43 publications

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“…Xanthogranulomatous cholecystitis is a rare variety of chronic cholecystitis 2 , 6 , 8 . XGC is a benign but occasionally aggressive disorder resulting from chronic inflammation of the gallbladder wall 1 .…”

Section: Discussionmentioning

confidence: 99%

“…XGC is a benign but occasionally aggressive disorder resulting from chronic inflammation of the gallbladder wall 1 . The prevalence ranges from 1 to 9% 1 , 6 . It usually occurs in the population older than 50 years and has no gender predominance 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory investigation shows an inflammatory pattern, and radiological signs are usually not conclusive 1 , 6 . Cholecystectomy, either open or laparoscopic, is performed for management 1 .…”

Section: Introductionmentioning

confidence: 99%

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Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: a case report

Rijal

Basukala²,

Shah³

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Xanthogranulomatous cholecystitis (XGC) is an uncommon type of chronic cholecystitis. Clinical presentation, laboratory findings, and radiological analysis mimic gallbladder carcinoma. A definitive diagnosis is made by histological study. Cholecystectomy, along with adjuncts as required, is performed for management. Case Presentation: We present a case of a 67-year-old female who was planned for interval cholecystectomy for gallstone pancreatitis. Her clinical, laboratory and radiological findings were suggestive of cholelithiasis and was planned for laparoscopic cholecystectomy. Her intraoperative findings mimicked gallbladder carcinoma. The surgery was aborted, and a biopsy was sent for histopathological analysis. XGC was diagnosed, and the patient underwent laparoscopic cholecystectomy with no postoperative complications during the 6-month follow-up period. Discussion: XGC is a rare disorder resulting from chronic inflammation of the gallbladder. There is the presence of xanthogranuloma with predominant lipid-laden macrophages in the gallbladder wall along with fibrosis. Clinical presentation, laboratory findings, and radiological analysis mimic gallbladder carcinoma. Ultrasonography usually shows diffuse wall thickening of the gallbladder, intramural hypoechoic nodules, unclear liver and gallbladder interface, and the presence of gallstones. The final diagnosis is made by histopathological analysis. Laparoscopic or open cholecystectomy, along with adjuncts as required, is performed for management with a low postoperative complication rate. Conclusion: XGC is a rare, benign disease that is often confused with gallbladder cancer before histological analysis. XGC can be managed with laparoscopic cholecystectomy with minimal postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: a case report

Rijal

Basukala²,

Shah³

et al. 2023

Annals of Medicine &Amp; Surgery

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“…In the present report, approximately half of the patients (5/10) experienced biliary colic, which cannot help diagnose XGC. Despite the existence of clinical, radiological and laboratory evidence, distinguishing XGC from gallbladder cancer remains challenging [ 14–16 ]; histopathology remains the gold standard [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

The incidental finding of xanthogranulomatous cholecystitis: a report of 10 cases

Alotaibi

Almasoudi

Ahmed

et al. 2022

Journal of Surgical Case Reports

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There is insufficient clinical knowledge about xanthogranulomatous cholecystitis (XGC) due to biased reporting. This study aims to investigate the incidence of XGC and evaluate the clinical outcome regarding operative time, rate of conversion and intraoperative or postoperative complications. We included 1141 patients who underwent surgery for gallbladder disease between January 2019 and December 2021. Of 1141 patients who underwent cholecystectomy, XGC was seen in 10 (0.87%). The average age is 47 (24–81 years old) with a male to female ratio of 3:2. Biliary pancreatitis and obstructive jaundice are seen in two patients who did ERCP and stenting before surgery. One patient presented with a 4 cm necrotizing soft-tissue granuloma. The BMI was high, with class I obesity in five patients. Symptoms last from 1 to 12 weeks. One patient was only diagnosed preoperatively as XGC. Four out of 10 (40%) required more than 72 h of hospitalization. All patients underwent elective sitting surgery, with eight successfully managed by laparoscopy and one converted to open. The average operative time was 90 min (43–193 min), and a postoperative drain was inserted in four patients. The median follow-up is after 24 months (11–30 months), with no postoperative collection, bleeding, complication or readmission. XGC is a rare benign entity requiring no further action upon incidental discovery. Surgical resection is the cornerstone of management, with the laparoscopic approach considered feasible and safe. Four out of 10 patients might need more than 3 days of hospitalization. In the presence of mass, the frozen section can help guide the management.

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“…However, the high conversion rate of laparoscopic cholecystectomy to open cholecystectomy in XGC is related to the difficulty in distinguishing GBC ( 13 ). Moreover, surgeons may perform improper surgery owing to the misdiagnosis of GBC ( 14 ). In this study, we retrospectively analysed 60 cases of XGC and 93 cases of GBC confirmed by histopathology to establish a diagnostic prediction model for XGC and GBC based on CT and MRI features to help clinical decision-making on the appropriate treatment method for patients with XGC.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning-Based Radiological Features and Diagnostic Predictive Model of Xanthogranulomatous Cholecystitis

et al. 2022

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BackgroundXanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that is sometimes indistinguishable from gallbladder cancer (GBC), thereby affecting the decision of the choice of treatment. Thus, this study aimed to analyse the radiological characteristics of XGC and GBC to establish a diagnostic prediction model for differential diagnosis and clinical decision-making.MethodsWe investigated radiological characteristics confirmed by the RandomForest and Logistic regression to establish computed tomography (CT), magnetic resonance imaging (MRI), CT/MRI models and diagnostic prediction model, and performed receiver operating characteristic curve (ROC) analysis to prove the effectiveness of the diagnostic prediction model.ResultsBased on the optimal features confirmed by the RandomForest method, the mean area under the curve (AUC) of the ROC of the CT and MRI models was 0.817 (mean accuracy = 0.837) and 0.839 (mean accuracy = 0.842), respectively, whereas the CT/MRI model had a considerable predictive performance with the mean AUC of 0.897 (mean accuracy = 0.906). The diagnostic prediction model established for the convenience of clinical application was similar to the CT/MRI model with the mean AUC and accuracy of 0.888 and 0.898, respectively, indicating a preferable diagnostic efficiency in distinguishing XGC from GBC.ConclusionsThe diagnostic prediction model showed good diagnostic accuracy for the preoperative discrimination of XGC and GBC, which might aid in clinical decision-making.

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Xanthogranulomatous cholecystitis: Diagnosis and management

Cited by 9 publications

References 43 publications

Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: a case report

Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: a case report

The incidental finding of xanthogranulomatous cholecystitis: a report of 10 cases

Machine Learning-Based Radiological Features and Diagnostic Predictive Model of Xanthogranulomatous Cholecystitis

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