Xanthogranulomatous cholecystitis: catching the culprit--clinical and imaging analysis.
BACKGROUND
Radiological and intraoperative findings of xanthogranulomatous cholecystitis (XGC) mimic carcinoma gallbladder (CaGB) leading to extended surgical resections and increased morbidity. We reviewed the clinical and CECT findings of histopathologically proven XGC and compared them with those of CaGB.


METHODS
The clinical and CECT findings from 22 patients with XGC were compared with 15 patients with CaGB manifesting as diffuse wall thickening.


RESULTS
GB wall thickness was similar in both groups (XGC 12.4 ± 3 mm, CaGB 13.9 ± 6.5 mm; p = 0.61). Intramural hypoattenuating nodules occupying >60% of the GB wall were suggestive of XGC, while the absence of nodules suggested CaGB (p = 0.017). The mucosal lining was intact and enhancing in XGC (20/22) and disrupted in CaGB (10/15; p = 0.001). Among adjacent organ infiltration, bile duct invasion resulting in obstruction was a significant finding in patients with CaGB (p = 0.04). Among XGC patients, 11 patients underwent radical cholecystectomy, 10 had open cholecystectomy and frozen section and 1 underwent bypass.


CONCLUSIONS
Though there is an overlap between XGC and CaGB, the presence of intramural hypoattenuating nodules occupying >60% of the diffusely thickened GB wall with intact mucosal line and the absence of obstructive features suggest XGC. In the presence of such imaging features, frozen biopsy should be done before proceeding with mutilating radical surgery.
Department of Gastrointestinal Surgery, GB Pant Hospital, New Delhi, India.
Sarika
S
Jain
Sundeep Singh
SS
Saluja
Ashok Kumar
AK
Sharma
Hridesh
H
Sant
Pramod Kumar
PK
Mishra
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000209:etiology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006099:Granuloma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed; D014973:Xanthomatosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
D003287:Contrast Media