title: Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases.
abstract: OBJECTIVE
  To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically.
  
  
  METHODS
  From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed.
  
  
  RESULTS
  The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05).
  
  
  CONCLUSIONS
  Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Yi-Lei
authors.initials: YL
authors.lastname: Deng
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Shui-Jun
authors.initials: SJ
authors.lastname: Zhang
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Ma
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Fu-Yu
authors.initials: FY
authors.lastname: Li
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Fei-Long
authors.initials: FL
authors.lastname: Xu
authors.affiliation: Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
authors.forename: Long-Shuan
authors.initials: LS
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005629:Frozen Sections; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006099:Granuloma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D014973:Xanthomatosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: Cholecystectomy; Frozen-section analysis; Gallbladder carcinoma; Xanthogranulomatous cholecystitis