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Abstract
Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mis-taken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.
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Fig. 1.
Preoperative gallbladder CT findings. (A) Approximately 8×5.1 cm sized heterogeneously enhancing mass with invasion to adjacent liver (segment 5/6) on gallbladder bed and overt peritoneal seeding and invasion or adhesion to adjacent colon. (B) Mild dilatation of both right and left intrahepatic bile ducts was seen.
Fig. 2.
Pathologic findings of xanthogranulomatous cholecystitis. (A) Gross features of the resected gallbladder. Note whitish yellow and thickened wall, up to 4 cm in wall thickness. (B-D) Microscopic features. (B) Mucosa was hemorrhagic and ulcerated, and wall was fibrotic (H&E, ×40). (C) Inflammatory cells heavily infiltrated in fibrotic stroma (H&E, ×200). (D) Numerous foamy histiocytes were ad-mixed with various inflammatory cells (H&E, ×400).
Fig. 3.
Postoperative abdominal CT findings. (A) Mild dilatation of both right and left intrahepatic bile ducts considering postoperative change was seen. (B) An overtly enlarged mass with infiltration in right hepatic lobe (about 3.8 cm) was seen (arrow).
Fig. 4.
Pathologic findings of adenocarcinoma. (A) Gross feature of the resected liver and intrahepatic bile duct. Note a whitish gray mass lesion at intrahepatic bile duct with invasion into liver. (B-D) Microscopic features. (B) Moderately differentiated, malignant gland formation was observed in bile duct. The uppermost surface of mucosa was totally denuded (H&E, ×40). (C) High power of B (H&E, ×200). (D) It showed that adenocarcinoma (left upper portion) invaded normal liver parenchyma (right lower protion) (H&E, ×100).
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