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Seo, Park, Kim, Kim, Choi, and Choi: Xanthogranulomatous Cholecystitis: A Retrospective Analysis of 36 Cases
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 76(6): 371-377.

Published online: 2 June 2009

DOI: https://doi.org/10.4174/jkss.2009.76.6.371

Xanthogranulomatous Cholecystitis: A Retrospective Analysis of 36 Cases

Sang-Hyuk Seo, M.D., Jeong-Ik Park, M.D., Jin-Soo Kim, M.D., Kwang-Hee Kim, M.D., Chang-Soo Choi, M.D., Young-Kil Choi, M.D.

Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Corresponding author (jeongikk@hotmail.com)

Received 9 January 2009       Accepted 11 February 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Xanthogranulomatous cholecystitis (XGC) is an uncommon, benign destructive and chronic inflammatory disease which is characterized by a marked proliferative fibrosis within the gallbladder wall. XGC occasionally involves adjacent organs and mimicking an advanced gallbladder carcinoma (GBC). The purpose of this study was to review the clinical manifestations, radiologic and pathologic findings of XGC and to investigate an appropriate treatment plan for patients with XGC.

Methods

We retrospectively analyzed the clinical data of 36 patients with a pathologic diagnosis of XGC operated between January 2003 and June 2008.

Results

The most frequent clinical symptom was biliary colic (88.8%). Radiologic studies revealed cholelithiasis in 30 patients (83.3%), thickening of gallbladder wall in 24 patients (66.6%), suspicious cancer in 11 patients (30.5%) and Mirizzi syndrome in 3 patients (8.3%). Laparoscopic cholecystectomy was planned in 18 patients but converted to open surgery in 9 patients. Open cholecystectomy was planned and performed in 13 patients including 8 cases of T-tube choledocholithotomy and 1 case of excision of a cholecystoduodenal fistula. Extended cholecystectomy was performed on 3 patients. GBC was suspected before operation in 11 patients. Of these, frozen-section biopsy was performed in 6 and found to be malignant in 1 patient. One patient who had no operative suspicion of malignancy turned out to have GBC at final histology.

Conclusion

XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis can be obtained by pathologic examination only. If there is an intraoperative suspicion of GBC, frozen-section biopsy will help to decide the appropriate mode of operation.

Keywords: Xanthogranulomatous cholecystitis, Gallbladder cancer, Cholecystectomy

Figures and Tables

Fig. 1
Several computed tomographic findings in patients with xanthogranulomatous cholecystitis. (A) CT scan shows focal gallbladder wall thickening and mass like lesion. This patient was diagnosed with gallbladder carcinoma preoperatively. (B) CT scan shows diffuse gallbladder wall thickening with multiple intramural hypoattenuated nodules. (C) CT scan shows irregular gallbladder wall thickening with hyperemic change of gallbladder bed, and pericholecytic infiltration.
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Fig. 2
Microscopic finding of xanthogranulomatous cholecystitis Xanthogranulomatous inflammation of the gallbladder wall, characterized by histocytes containing neutral fat and lipofucin pigment (H&E, ×200).
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Table 1
Clinical manifestation in 36 patients with xanthogranulomatous cholecystitis
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*some of the patients had more than one clinical manifestation.

Table 2
Associated diseases in patients with xanthogranulomatous cholecystitis
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Table 3
Computed tomographic findings in 36 patients with xanthogranulomatous cholecystitis
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Table 4
Summary of operative procedures
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*combine with right intrahepatic duct stone; †combine with distal common bile duct cancer; ‡combine with gastric cancer.

Table 5
Postoperative complications in patients with xanthogranulomatous cholecystitis underwent cholecystectomy
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*due to T tube removal by patient himself.

Table 6
Profiles of patients with radiologically suspected gallbladder carcinoma
jkss-76-371-i006

*additional operation was not performed due to patient's refusal; †LC = laparoscopic cholecystectomy; ‡EC = extended cholecystectomy; §OC = open cholecystectomy; ∥TTC = T-tube choledocholithotomy; TG = total gastrectomy; **RH = right hepatectomy; ††PD = pancreaticoduodenectomy; ‡‡XGC = xanthogranulomatous cholecystitis; §§GBC = gallbladder carcinoma.

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