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Background: Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis which may involve adjacent organs including liver, colon and duodenum mimicking gallbladder cancer. Preoperative differentiation of xanthogranulomatous cholecystitis from gallbladder cancer is often difficult and the final diagnosis is usually made on histopathology of the resected specimen. Methods: We report four cases of xanthogranulomatous cholecystitis which were misdiagnosed as cases of advanced gallbladder cancer based on presentation and radiological findings. Results: All the four patients presented with history of upper abdominal pain while two patients had history of associated weight loss. Radiological features were strongly suggestive of gallbladder cancer with involvement of adjacent organs in all cases. Based on the imaging findings, these patients underwent radical resections but the final histopathology was a diagnostic surprise. Conclusion: Xanthogranulomatous cholecystitis is still a diagnostic challenge as no clinical and imaging modality has been helpful to make a definitive diagnose of this entity. We review the role of available diagnostic modalities in this challenging area of uncertainty. Radical resection may be justified in patients who present with the features mimicking gallbladder cancer.

Cruces university hospital, Hepatobiliary and liver transplant unit, Bilbao, Spain Background: Surgery is the only curative treatment for biliary cancer.Unfortunately most patients are diagnosed at an advanced stage.Current treatments for distant disease include radiation and chemotherapy with exceptional complete response and long-term survival. Trastuzumab is a monoclonal antibody that targets HER-2.Overexpression of HER-2 has been described in gallbladder cancer and cholangiocarcinoma Methods: We present the first case described of surgical treatment in stage IV gallbladder adenocarcinoma after complete radiological, metabolic and biochemical response Results: We present a 44-year-old male diagnosed of gallbladder cancer with liver and distant lymph nodes metastases. Ca19.9 22,000 U/ml.Metastases biopsy showed adenocarcinoma with bile duct origin. Cisplatin and Gemcitabine were started with disease progression.Immunohistochemistry showed intense positivity for HER-2.Chemotherapy was swiched to Oxaliplatin and Capecitabine associated to Trastuzumab.Progressively a complete radiological, metabolic and biochemical response was seen.A mesohepatectomy associated with hiliar and interaortocava lymphadenectomy was performed (pT2N0M0).After 3 years no recurrence has been observed. Conclusion: Although, no conclusions can be drawn from a single case, Trastuzumab should be considered in patients with gallbladder adenocarcinoma at advance stage overexpressing HER-2.