title: Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases.
abstract: BACKGROUND
  Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC.
  
  
  METHODS
  The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5:1).
  
  
  RESULTS
  Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients.
  
  
  CONCLUSIONS
  XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.
authors: Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. yangtian6666@hotmail.com
authors: Tian
authors: T
authors: Yang
authors: Bai-He
authors: BH
authors: Zhang
authors: Jin
authors: J
authors: Zhang
authors: Yong-Jie
authors: YJ
authors: Zhang
authors: Xiao-Qing
authors: XQ
authors: Jiang
authors: Meng-Chao
authors: MC
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods*; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014973:Xanthomatosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*