Cholecystitis Xanthogranulomatous cholecystitis. Author: Hanni Gulwani, M.D. (see Authors page) Revised: 2 February , last major update September The purpose of our study was to evaluate the sonographic and CT features of xanthogranulomatous cholecystitis, correlating the pathologic and surgical findings. Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation Abstract · INTRODUCTION · PATHOLOGY · RADIOLOGICAL FINDINGS.
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Xanthogranulomatous cholecystitis we have tried to give a concise review of this entity emphasizing on radiological and pathological aspects. Few points in differential diagnosing with other entities especially carcinoma gallbladder have also been entailed.
The nomenclature was done by McCoy et al[ 2 ] in though it was first described in by Christensen et al[ 3 ].
Christensen et al[ 3 ] and Amazon et al[ 4 ] had noted a pseudotumoral form of chronic cholecystitis that was characterized by the presence of xanthoma-like foam cells and scarring and that contained ceroid wax-like nodules in an inflammed gallbladder wall.
They used the terms fibroxanthogranulomatous inflammation and ceroid granulomas of the gallbladder, respectively, which are now known as synonyms of XGC[ 34 ]. It occurs in a wide range of age groups but the incidence is higher in the sixth and seventh decades of life.
Male preponderance has been reported with a male to female ratio of 2: However one of the Indian studies found a marked female preponderance with a xanthogranulomatous cholecystitis to female ratio of 1: Xanthogranulomatous cholecystitis, these clinical features are not specific for XGC and often no clinical difference between patients with XGC and carcinoma gallbladder can be found[ 9 ].
Xanthogranulomatous cholecystitis | Radiology Reference Article |
Leukocytosis has been observed though there is no specific biochemical test or liver function discordance pointing towards the diagnosis of XGC. Thirteen histologically confirmed cases of xanthogranulomatous xanthogranulomatous cholecystitis were identified from the retrospective analysis of the patient records of cholecystectomies performed during the period January to March at the Hakeem Abdul Hameed Centenary Hospital, New Delhi.
The clinical, radiological and operative details of these patients have been analysed. Chronic right upper quadrant pain was the most common clinical presentation. In 2 patients, a gall bladder carcinoma was suspected radiologically as well as clinically, but was later disproved on histology.
On retrospect, at least one of these findings was noted in Discussion XGC can exhibit similar imaging and intraoperative findings as xanthogranulomatous cholecystitis of GBC and are easily misdiagnosed, often leading to unnecessary radical surgery [ 1413 ].
An increased awareness combined with an increased accuracy of preoperative and intraoperative diagnosis and an algorithmic approach to XGC could help avoid extended xanthogranulomatous cholecystitis.
Analogous to the results of a Chinese study, our data suggests that the presence of abdominal pain, acute cholecystitis, choledocholithiasis, and cholelithiasis may portend a xanthogranulomatous cholecystitis of XGC [ 6 ].
Xanthogranulomatous cholecystitis--a diagnostic challenge.
The role of tumour markers remains unresolved, with some studies showing no significant correlations with diagnosis [ 235 xanthogranulomatous cholecystitis, 6 ]. Extravasation of bile into the gallbladder wall with involvement of Rokitansky-Aschoff sinuses is a potential precipitating factor for XGC [ 6 — 12 ].
These lead to formation of submucosal abscesses or xanthogranulomas, which show up on CECT as submucosal hypoattenuated nodules occupying large areas of the gallbladder wall, a xanthogranulomatous cholecystitis highly suggestive of Xanthogranulomatous cholecystitis.
Other features like the continuous mucosal line in a thickened gallbladder wall and the presence of gallstones in a background xanthogranulomatous cholecystitis chronic gallbladder disease have been reported as being highly suggestive of Xanthogranulomatous cholecystitis [ 6 — 12 ].
The radiological findings indicative of XGC in our series concurred with those reported in literature. Even though EUS-FNA is a feasible and safe method for obtaining samples, its xanthogranulomatous cholecystitis in the diagnostic workup of gallbladder lesions remains undefined.
Intraoperative frozen section examination is an xanthogranulomatous cholecystitis method for exclusion of GBC. Frozen section in combination with immunohistochemistry has shown to be xanthogranulomatous cholecystitis sensitive in their ability to differentiate XGC from GBC [ 18 ].
Controversy exists regarding the use of laparoscopic cholecystectomy LC in patients with XGC [ 19 — 21 ].
Xanthogranulomatous cholecystitis: What every radiologist should know
The intense chronic inflammatory process can make the xanthogranulomatous cholecystitis arduous and hazardous, and hence in any patient with a difficult laparoscopic cholecystectomy, an on-table differential diagnosis of XGC must be entertained amongst others.
Multiple series have attested to the safety of LC in XGC, with no increase in the morbidity as compared to an open procedure. There is indeed a higher incidence of conversion to an open procedure, but this low threshold for conversion to open surgery enables a better assessment of the lesion and results in superior outcomes with regard to mortality and morbidity [ 13 xanthogranulomatous cholecystitis, 19 — 21 ].
A combination of clinical, radiological factors combined with a liberal application of intraoperative frozen section examination can aid in the diagnosis and surgery for XGC. To help guide the surgeon towards a structured and rationalized management of XGC, based on our study, a simple algorithm has been proposed Figure 4.