An Important Gallbladder Pathology Mimicking Gallbladder Carcinoma: Xanthogranulomatous Cholecystitis: A Single Tertiary Center Experience

Abstract

Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal, or diffuse destructive inflammatory disease of the gallbladder mimicking or being together with the gallbladder carcinoma. This study aimed to evaluate the diagnosis, treatment, and outcomes of patients with XGC as a single tertiary center experience in the light of literature. Materials and Methods: Data about 34 patients with XGC identified after evaluating 2212 cholecystectomy specimens between January 2013 and December 2018 in a single tertiary center were documented to determine demographics (sex, age), clinical symptoms and findings, biochemical and imaging clues and operative findings, duration of hospitalization, postoperative complications, and histopathologic results. Results: Thirty-four patients with XGC were evaluated (17 male and 17 female patients with a mean age of 53; range, 25 to 78). Preoperative diagnosis was chronic calculous cholecystitis in 5 patients, cholelithiasis in 12 cases, acute calculous cholecystitis in 16 and emphysematous cholecystitis in 1 patient. Ultrasound was performed in all patients, computerized tomography in 11, contrast-enhanced magnetic resonance imaging in 9, and magnetic resonance cholangiopancreatography in 7 patients. None of the patients were diagnosed preoperatively. All patients received laparoscopic cholecystectomy, among whom 9 were converted to open. Partial cholecystectomy was performed in 1 patient. One patient with gallbladder adenocarcinoma was treated with radical cholecystectomy. XGC has nonspecific clinical and radiologic findings; thus, preoperative diagnosis is generally absent. Open cholecystectomy is the recommended treatment modality. Conversion to open is frequently necessary after laparoscopy. Complete cholecystectomy is the ultimate goal; however, partial cholecystectomy may be preferred to protect the structures of the hepatic hilum. Preoperative imaging studies (ultrasound or computerized tomography) of 34 patients showed a gallbladder stone in 18 patients, microlithiazis in 12 patients, sludge in 10 patients, and gallbladder sclerosis in 5 patients. Conclusions: Diagnosis of XGC and differentiation from gallbladder carcinoma may be difficult through preoperative or peroperative studies, even imaging is useful; the definitive diagnosis depends exclusively on pathologic examination. The surgeon should be prepared for every possibility.

Diagnostic Point-of-Care Ultrasound (POCUS) for Abdominal Pain: A Case of Tumefactive Sludge

“…Due to its high viscosity, the movement of the biliary sludge is poor or very slow, which often leads to a mass-like configuration, called tumefactive biliary sludge [3,7]. In view of this pseudotumor configuration associated with the absence of movement detected on ultrasound, a tumefactive biliary sludge is often confused with a polypoid vesicle or with neoplastic vesicular disease [3,6,7,9]. Despite its low sensitivity, the absence of a doppler signal at the level of the lesion helps to differentiate it from neoplastic pathology, typically characterized by high vascularization [5].…”

The utility of systemic immune inflammatory index in discriminating between gallbladder cancer and xanthogranulomatous cholecystitis: A single-tertiary center experience

“…Thus, previous studies focused on differentiating GBC and XGC according to clinical and radiological findings, for which the results are inconclusive and scarce. [25][26][27][28] A definitive diagnosis still depends on postoperative pathological examination. [6] The lack of diagnosis preoperatively or intraoperatively may result in over or under-treatment of patients; therefore, it is essential to have a noninvasive and useful method to distinguish the XGC and GBC before surgery is carried out.…”

Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: A diagnostic and therapeutic dilemma

“…The true incidence of XGC is unknown, ranging widely from 0.7% to 13.2% of all inflammatory gallbladder pathology [7] . Geographical variations in incidence are also considerable, with most case being reported from East and Southern Asian populations while there is very limited research in North America [8] .…”