Xanthogranulomatous Cholecystitis Mimicking Gall Bladder Cancer: a Diagnostic Dilemma and Review of Literature

Abstract

Xanthogranulomatous cholecystitis (XGC) is one of the rare variants of chronic cholecystitis which is characterized by inflammation of gall bladder along with infiltration by acute and chronic inflammatory cells. Intramural accumulation of lipid laden macrophages in GB wall is the hallmark of the disease. XGC results in dense adhesion of gall bladder (GB) to surrounding structures, like duodenum, colon, and stomach. The intense GB inflammation results in gall bladder perforation and development of fistulous communication between gall bladder and surrounding structures. This may also lead to formation of inflammatory mass which closely mimic gall bladder malignancy. Often differentiation from carcinoma of GB (Ca GB) on the basis of clinical presentation and even on intra-operative and radiological findings is difficult, and the issue could only be resolved on final Histopathology (HPE). We review presentation and investigation of a patient, discuss our approach in managing dilemma in treating such cases of XGC, and review the literature.

Keywords: Cholecystitis; Gall bladder cancer; Radical cholecystectomy; Xanthogranulomatous cholecystitis.

Fig. 1

Infiltration of gall bladder mass in to liver parenchyma

Fig. 2

Loss of fat plane between gall bladder mass and liver

Fig. 3

Dense adhesion between gallbladder and duodenum

Fig. 4

Cholecystoduodenal fistula

Fig. 5

Hematoxylin and eosin–stained microphotographs of the cholecystectomy specimen: A (40 ×) Intact benign mucosal epithelium with dense chronic inflammation and deeper foamy macrophages accompanied by cholesterol clefts and giant cell response. B (200 ×) Red arrows pointing to foamy macrophage aggregates, blue arrows pointing to cholesterol clefts, and black arrows pointing to the giant cells