Computed Tomography (CT) and Magnetic Resonance (MR) Findings in Xanthogranulomatous Cholecystitis: Retrospective Analysis of Pathologically Proven 30 Cases – Tertiary Care Experience

Abstract

SummaryBackgroundTo study CT and MR findings in xanthogranulomatous cholecystitis (XGC).Material/MethodsRetrospective analysis of 30 histopathologically confirmed cases of XGC. Seventeen patients underwent CECT and 13 underwent MRI. The following features were studied – wall thickness, intramural nodules, pericholecystic stranding, wall thickness, THAD, fat in gallbladder wall, cholelithiasis, infiltration, biliary dilatation, lymph nodes, complications.ResultsThe majority of cases (22/30) showed discontinuous mucosal lining. Discontinuous mucosal lining was seen in all cases with wall thickness >10 mm, 75% of cases with wall thickness between 3–10 mm and none in normal wall thickness (p=0.03). Diffuse wall thickening was seen in 23 cases, focal thickening in 3 and polypoidal wall thickening in 2 cases. Polypoidal thickening was seen in gallbladder carcinoma. Intramural nodules were present in 87.5% of cases with discontinuous mucosal lining. Pericholecystic stranding was seen in 19, biliary dilatation in 12, liver infiltration in 13 and fat in 7 cases. Lymphadenopathy was seen in 1 case with gallbladder carcinoma. Four cases showed a signal drop in the intramural nodules on chemical shift MRI.ConclusionsDiscontinuous mucosal lining is evident in xanthogranulomatous cholecystitis. Diffuse wall thickening, intramural nodules, continuous or discontinuous mucosal lining and cholelithiasis may indicate XGC rather than gallbladder carcinoma. Based on correlation with pathophysiological findings, we conclude that discontinuous mucosal lining is not an unusual finding in cases of XGC. Advances in knowledge: Being aware of the radiological findings described in this article may be helpful in making preoperative radiological diagnosis of XGC. Mucosal lining may be continuous or discontinuous in XGC.

Xanthogranulomatous Cholecystitis: Our Clinical Experience

“…However, the CT and MRI findings were not considered specific or diagnostic for XGC and still suggested GBC. There was disseminated thickness in the gallbladder wall in most of the patients (61.1%), and three patients had the characteristics of XGC on MRI, such as intramural T2-high signal intensity and continuous enhancing mucosal line with preserved mucosal layering, which helped to differentiate it from GBC (10,11).…”

Chronic gallbladder wall thickening: Is it always malignancy?

“…The most important association with XGC is cholelithiasis, seen in approximately 66.6% of patients. 4 The hypothesis behind the pathogenesis of this condition is GB outflow or cystic duct obstruction by calculi, leading to a rupture of the Rokitansky-Aschoff sinuses, causing bile leakage into the wall of the GB. 5 Bile is then engulfed by macrophages and foamy histiocytes, resulting in a chronic granulomatous response, microabscess formation, subsequent wall fibrosis and scarring.…”

“…1 Pericholecystic fat stranding, blurring of the interface with liver, oedema, transient hepatic attenuation differences or early enhancement may be appreciated in the adjacent liver parenchyma. 4 Zhao et al 6 observed that the co-existence of at least four out of the five CT features (diffuse GB wall thickening, hypoattenuating intramural nodules, continuous mucosal line, LSE and gallstones) was found in 80% cases of histologically proven XGC. 6 On dynamic contrast-enhanced MRI, areas of T2 isointensity showing early and strong delayed enhancement suggest xanthogranulomas, whereas high T2 signal lesions without enhancement suggest microabscesses.…”

Contribution of Cytology for the Diagnosis of Gallbladder Carcinoma to Avoid Misdiagnosis in This Commonly Resected Organ

“…It will be the same in the absence of bile in the gallbladder (sclero-atrophic gallbladder). In this case, the histological examination of the specimen will remain the only means of diagnosis using modern examinations more efficient [14].…”