Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm

Abstract

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

Keywords: Aortic aneurysm, abdominal; Gallbladder neoplasms; Xanthogranulomatous cholecystitis.

Figure 1

(A) A xial computed tomography (CT) scan of the abdomen showing a large abdominal aortic aneurysm and xanthogranulomatous cholecystitis. (B) CT scan obtained one week after percutaneous drainage of the gallbladder empyema. Note persistence of the hypodense nodules within the gallbladder wall (arrows).

Figure 2

(A) Photograph of the resected gallbladder shows xanthogranulomatous changes within the thick wall gallbladder appearing as yellow nodules (arrows) seen earlier on computed tomography scans. (B) Gallbladder histology shows chronic inflammation with a predominance of foamy macrophages (H&E, × 400).

Figure 3

H&E section shows diffusely invasive adenocarcinoma of the gallbladder with dysplastic surface epithelium (H&E, × 200).