The value of conventional ultrasound combining with contrast-enhanced ultrasound in the diagnosis of xanthogranulomatous cholecystitis / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in improving the diagnosis ability for xanthogranulomatous cholecystitis ( XGC ) and wall-thickening gallbladder cancer ( GBC) . Methods Forth-three patients with XGCs and 31 patients with wall-thickening GBCs proved by pathology were enrolled in this study ,the features on conventional ultrasound and CEUS were recorded ,and the preliminary diagnosis before and after CEUS were given by doctors . Results Significant differences were found in continuous gallbladder inner wall and arterial blood supplement on conventional ultrasound , 58 .1％ (25/43) had continuous inner wall and 34 .9％ (15/43) had arterial blood flow in XGCs compared to 19 .4％ (6/31) and 100％ in GBCs . On CEUS ,72 .1％ (31/43) demonstrated continuous gallbladder inner wall and 48 .8％ (21/43) had hypoechoic nodules in the wall in XGCs compared to 16 .1％ (5/31) and 19 .4％ (6/31) in GBCs ,respectively ( P <0 .05) . No significant difference was found in intra-calcification , infiltration to adjacent organs ,gallbladder stones and fast-in and fast-out enhanced pattern( P >0 .05) . The area under ROC curve was improved from 0 .701 to 0 .899 after combining with CEUS ( P < 0 .05 ) . Conclusions Conventional ultrasound combining with CEUS could help acquiring more effective ultrasonic information and may improve the differential diagnosis ability of XGCs and GBCs .

XANTHOGRANULOMATOUS CHOLECYSTITIS: A DIAGNOSTIC DILEMMA

@#Xanthogranulomatous cholecystitis is a rare histopathological finding and accounts for 1.3% to 5.2% of cases. It closely resembles gallbladder cancer because of its extensive inflammation and involvement of the surrounding organs. We are reporting a case where it presents as an extensive inflammatory mass mimicking gallbladder cancer.

Surgical treatment of xanthogranulomatous cholecystitis: a report of 56 patients / 中华肝胆外科杂志

Objective To study the surgical treatment of xanthogranulomatous cholecystitis (XGC).Methods We retrospectively analyzed the clinical data of 56 patients with XGC who underwent surgical treatment at the Zhejiang Provincial People's Hospital from May 2010 to May 2017.Results The diagnosis of XGC was confirmed by histopathology.On preoperative examination of the 56 patients,42 patients had various degrees of increase in the CA19.9 levels,41 patients (73.2％) had thickened gallbladder walls with continuous mucosal linings on ultrasonography,CT,or MRI,and 18 patients (32.1％) had thickening of gallbladder walls with low density nodules.Gallbladder stones were present in 51 patients (91.1％) and 4 patients (7.2％) presented with Mirizzi syndrome.The 41 patients (73.2％) who were diagnosed as XGC before operation under laparoscopic surgery and 7 patients (17.1％) were converted to open surgery.The remaining 15 patients (26.8％) underwent open operation directly because of uncertainty in the diagnosis.All the patients had frozen section during operation.The postoperative pathological results included 21 localizedtype (37.5％) and 35 diffuse type (62.5％) of XGC.All 56 patients had no long-term complications on followed-up for 0.5～ 6 years.Conclusions XGC is a special kind of chronic cholecystitis.There is difficulty in differentiating from gallbladder cancer before surgery.The diagnosis of XGC mainly depends on ultrasonography,CT or MRI.Cholecystectomy is the treatment for XGC.Laparoscopic surgery is the first line treatment for XGC.

Differential diagnosis and surgery for gallbladder carcinoma and xanthogranulomatous cholecystitis / 中华肝胆外科杂志

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: an analysis of 42 patients / 中华肝胆外科杂志

Objective To study the clinical features of xanthogranulomatous cholecystitis (XGC),and to analyze the difficulties in the differential diagnosis of XGC with gallbladder carcinoma.Methods The clinical data of 42 patients who were diagnosed preoperatively as gallbladder cancer in our hospital from 2008 to 2016 were retrospectively analyzed.Results Of the 42 patients,upper abdominal CT scans were carried out in 38 patients,and MRI examination in 4 patients.Imaging findings showed unclear boundaries between the liver and the gallbladder in 37 patients,and unclear boundaries between the gallbladder and the adjacent tissues in 16 patients.In 11 patients,the regional lymph nodes were enlarged.22 patients had gallstones.All the 42 patients had gallbladder wall thickness of ≥3 mm.In 27 patients there were diffuse thickenings of the gallbladder wall,while in 15 patients there were only local thickenings.In 35 patients,inhomogeneous enhancement of the gallbladder wall was shown on CT enhancement scanning,and in 11 patients,there were low attenuation nodules in the gallbladder wall.All the 42 patients underwent surgical treatment.During surgery,dissection of the gallbladder triangle was difficult because of dense adhesion of the gallbladder with the surrounding tissues.In 32 patients,the gallbladder was adherent to the omentum,in 16 patients to the duodenum,in 12 patients to the colon,and in 8 patients to the stomach.In 30 patients,intraoperative frozen sections were carried out.Two patients were diagnosed to have early gallbladder cancer (T1a GBC).In 12 patients who did not receive frozen section during operation,6 patients were subsequently diagnosed to have XGC and 6 patients to have gallbladder cancer.The types of surgical treatment given to these patients were according to the intraoperative diagnosis or frozen sections results.After surgery,one patient each developed surgical site infection in the total cholecystectomy group as well as in the partial cholecystectomy group.In addition,one patient had bile duct injury and another patient had duodenal injury in the total cholecystectomy group.There was one patient who had residual biliary stone in the partial cholecystectomy group.The difference in the postoperative complication rates between the two groups was not significant (P ＞ 0.05).Conclusions It is difficult to differentiate XGC from gallbladder cancer based on clinical and imaging findings.The final diagnosis still depends on histopathological examination.

Gastric Outlet Obstruction arising from Xanthogranulomatous Cholecystitis accompanied by both Cholecystoduodenal and Cholecystocolonic Fistulas / 대한췌담도학회지

Xanthogranulomatous cholecystitis (XGC) is a rare type of chronic inflammation of the gallbladder characterized by focal or diffuse destructive inflammatory responses. Although it is a benign condition, its destructive course may lead to more aggressive outcomes of the gallbladder, such as local infiltration, fistula, stricture, and perforation as compared with other gallbladder inflammations. There are reports about XGC accompanied by cholecystoenteric fistula. However, XGC accompanied by more than one cholecystoenteric fistula is rare. We report a case of a 54-year-old man with gastric outlet obstruction arising from XGC, accompanied by cholecystoduodenal fisula and cholecystocolonic fistula, but without impacted gallstones.

A Case of Xanthogranulomatous Cholecystitis Decreased in Size after Steroid Treatment and Avoided Extended Resection / 대한췌담도학회지

Xanthogranulomatous cholecystitis is an uncommon destructive inflammatory disease with accumulation of lipid-laden macrophages, fibrous tissue, and inflammatory cells. It is often mistaken for gallbladder cancer due to diffuse wall thickening of gallbladder and infiltration into neighboring organs. And it is usually difficult to distinguish xanthogranulomatous cholecystitis from gallbladder cancer based on clinical, radiographic, or laboratory testing. Patients with xanthogranulomatous cholecystitis often undergo cholecystectomy to confirm the diagnosis, and to exclude gallbladder cancers. We report a case of 69-year-old woman with xanthogranulomatous cholecystitis who had been treated with steroid and avoided extended resection.

Xanthogranulomatous cholecystitis: A rare radiological diagnosis.

Xanthogranulomatous cholecystitis [XGC] is an unusual focal or diffuse destructive inflammatory process of the gallbladder that may mimic a malignant neoplasm with associated complications. We present a rare case of Xanthogranulomatous cholecystitis with associated complications of liver abscess and enterobiliary fistula that was diagnosed radiologically and confirmed on histopathology.

Xanthogranulomatous cholecystits in 2-month-old infant / 대한외과학회지

Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis that is accompanied by xanthomatous histiocytes and chronic inflammation. A 2-month-old boy presented with a right upper abdominal palpable mass. Cholecystectomy with liver wedge resection was done, under the impression that the mass might be a hepatic tumor or liver abscess. Pathologic examination showed XGC with abscess formation. Most cases of XGC were observed in adult and only a few cases were reported in children. We describe a very rare case of XGC in infancy.

Simultaneous Xanthogranulomatous Cholecystitis and Gallbladder Cancer in a Patient with a Large Abdominal Aortic Aneurysm

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

Colecistite xantogranulomatosa simulando adenocarcinoma de vesícula biliar: relato de caso / Xanthogranulomatous cholecystitis mimicking gallbladder adenocarcinoma: Case report

A colecistite xantogranulomatosa é uma doença rara caracterizada for intensa fibrose que pode ser uma causa de dificuldade técnica na realização de colecistectomia tanto por cirurgia laparoscópica quanto aberta. Casos de colecistite xantogranulomatosa podem ser frequentemente confundidos com carcinoma de vesícula biliar localmente avançado na avaliação intra-operatória fato esse que pode acarretar em uma resseção alargada. Os autores relatam um caso de paciente com colecistite xantogranulomatosa que simulou adenocarcinoma de vesícula biliar localmente avançado tanto a avaliação intraoperatória quanto a biópsia de congelação. O doente foi submetido a ressecção estendida (bissegmentectomia IV+V) com linfadenectomia hilar e não houve intercorrências. À análise histológica definitiva, observou-se tratar de colecistite xantogranulomatosa.

Xanthogranulomatous cholecystitis is a rare disease characterized by severe fibrosis that can be a cause of technical difficulty in performing cholecistectomy (either laparoscopic or open surgery). Patients with xanthogranulomatous cholecystitis can be frequently confounded at intraoperative evaluation with gallbladder carcinoma, this fact can lead to an extended resection. The authors report one case of xanthogranulomatous cholecystitis that mimicked gallbladder adenocarcinoma at intraoperative evaluation by frozen-section. The patient was submitted to an extended resection (bisegmentectomy IV+V) with hilar lymphadenectomy. He carried out without postoperative complications. Definitive histological analysis revealed xanthogranulomatous cholecystitis.

A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma / 대한소화기학회지

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

Distinguishing Xanthogranulomatous Cholecystitis from the Wall-Thickening Type of Early-Stage Gallbladder Cancer

BACKGROUND/AIMS: Xanthogranulomatous cholecystitis (XGC) mimics early-stage gallbladder (GB) cancer with wall thickening on computed tomography (CT), both clinically and radiologically. Preoperative differentiation of XGC from early-stage GB cancer is important for selecting the most appropriate surgical management. Therefore, we evaluated the clinical features and multidetector CT (MDCT) findings of XGC to determine whether it can be distinguished from early-stage GB cancer. METHODS: We retrospectively evaluated 25 patients with XGC and 56 patients with the wall-thickening type of T1- and T2-stage GB cancer, where all of the diagnoses were pathologically confirmed by surgical treatment. All of the patients underwent preoperative MDCT. The clinical symptoms, laboratory findings, and CT findings were compared. RESULTS: Abdominal pain, fever, and jaundice were noted more frequently in the patients with XGC. Serum aspartate aminotransferase and alanine aminotransferase levels were more elevated in patients with XGC, whereas carbohydrate antigen (CA 19-9) was higher in the patients with GB cancer. When the T-category cancer staging of XGC and early-stage GB cancer were compared, diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration were consistent significant findings associated with XGC, regardless of the cancer staging. CONCLUSIONS: MDCT findings such as diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration together with the clinical symptoms, can provide clues for physicians to differentiate XGC from early-stage GB cancer with wall thickening on CT.

Xanthogranulomatous Cholecystitis: A Retrospective Analysis of 36 Cases

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.

Xanthogranulomatous Cholecystitis Not Associated with Gallstone in a 9-year-old Girl

Xanthogranulomatous cholecystitis (XGC) is known to be a rare, variant type of chronic cholecystitis and more frequently found in the adults with a prevalence of 0.7 to 13.2% of all cholecystitis, moreover very rare in children. Clinically, this usually presents as chronic or acute cholecystitis associated with gallstones, but biliary colic is unusual. Although it requires surgery for management, it may accompany some difficulties during cholecystectomy and postoperative complications such as biliary fistula. It could also give rise to higher conversion rates than other diseases of the gallbladder during laparoscopic procedures. We experienced a very rare pediatric case of xanthogranulomatous cholecystitis not associated with gallstones, successfully managed by laparoscopic cholecystectomy and hereby report it with literature reviews.

Características clínicas y epidemiológicas de la colecistitis crónica xantogranulomatosa / Xanthogranulomatous cholecystitis: clinical and epidemiological characteristics

La Colecistitis Xantogranulomatosa (CXG) es una rara enfermedad inflamatoria de la vesícula biliar, variedad de la colecistitis crónica. El objetivo de este estudio fue describir las características clínicas y epidemiológicas de una serie de pacientes con éste diagnóstico. De un total de 1486 colecistectomías realizadas entre los años 2004 y 2006 se encontraron 48 casos de CXG (3,23% del total). La mayoría corresponde a mujeres (67,4%) con 53,5 años de edad promedio. El cuadro clínico fue similar al de la colecistitis crónica, con un tiempo de evolución que varió de 1 semana a 10 años. 19% de los pacientes refirieron antecedentes de Ictericia, aunque en sólo 1 de ellos había dilatación de la vía biliar en la Ecografía. Todos eran portadores de cálculos en la vesícula biliar, la cual fue la principal indicación quirúgica. En 4 de ellos se sospechó la presencia de Cáncer Vesicular por imagenología y en 8 por las características macroscópicas de la vesícula biliar durante la cirugía. Sólo en un paciente coexistió CXG y Adenocarcinoma de la Vesícula Biliar. El diagnóstico de CXG no fue planteado en ninguno de los casos. Ésta es una patología de baja prevalencia y difícil diagnóstico. Su incidencia en esta serie fue mayor a la reportada por otros estudios. Clínicamente es difícil diferenciarla de la colecistitis crónica y frecuentemente se confunde con Cáncer vesicular. Ambos diagnósticos pueden coexistir, lo que ocurrió en nuestra serie en el 2,17%. No hubo diferencia significativa en la frecuencia de Adenocarcinoma de Vesícula biliar entre los pacientes con CXG y aquellos con otro tipo de Colecistitis crónica.

Xanthogranulomatous Cholecystitis (XGC) is a rare inflammatory disease of the gallbladder, variant of Chronic Cholecystitis. The aim of this study was to describe the epidemiology and clinical data of one series of patients with this diagnosis. Of a total of 1486 cholecystectomies performed between 2004 and 2006, we found 48 cases of XGC (3.23% of total). The most of them were women (67.4%) with an average age of 53.5 years. The clinical history was similar to Chronic Cholecystitis with a variable duration of the symptoms, from 1 week to 10 years. 19% of the patients had antecedents of Obstructive Jaundice, although just one had dilatation of the choledocus at ultrasound. All the patients had Cholelithiasis, the mayor reason for surgery. Four of our cases had findings on ultrasound examination suggestive of carcinoma of gallbladder and at operation in eight patients the appearances of the gallbladder resembled carcinoma to the surgeons. In none of them the diagnosis was confirm and just in one patient was found association between XGC and gallbladder cancer, without previous suspicion. The diagnosis of XGC was never suspected. This is an uncommon entity with difficult diagnosis. The incidence in our study was higher than other reports. Clinically is hard to distinguish from Chronic Cholecystitis, and is often confused with Gall Bladder Carcinoma. As other authors support, both diagnosis can coexist, what occurred in 2.17% of the patients in our series. There was no significant difference in the frequency of Gall Bladder Carcinoma between the patients with CXG and those with another type of chronic Cholecystitis.

Premalignant Lesions of Gallbladder Carcinoma and Treatment / 영남의대학술지

Carcinoma of the gallbladder is an uncommon but highly malignant tumor with a poor five year survival rate. Early detection is very important for successful treatment because this tumor is very hard to cure in cases where it has advanced beyond the reach of surgical treatment. The purpose of this review was to evaluate risk factors for carcinoma of the gallbladder and determine the best management approach.. Solitary polys, more than one cm are considered to be predisposing factors for gallbladder carcinoma when they are found to be echopenic, sessile, and with a high cell density. Anomalous union of the pacreato-biliary duct(AUPBD) without a choledochal cyst is also considered to increase risk for gallbladder carcinoma. A polyps size of more than one cm and an AUPBD are indications for prophylactic cholecystectomy. The presence of gallstones is a well-established risk factor for the development of gallbladder carcinoma; risk appears to correlate with the stone size and the duration of chronic cholecystitis. Metaplastic changes of the gallbladder epithelium present with chronic cholecystitis and may indicate a premalignant lesion. Abnormal forms of cholecystitis such as xanthogranulomatous or a porcelain gallbladder also have malignant potential; cholecystoenteric fistula as well as bacterial infection of the gallbladder(typhoid, helicobacter species) also has malignant potential. In this review, the risk factors associated with carcinoma of the gallbladder are summarized with special attention to gallstones, polyps,AUPBD, and chronic inflammation.

Premalignant Lesions of Gallbladder Carcinoma and Treatment / 영남의대학술지

Carcinoma of the gallbladder is an uncommon but highly malignant tumor with a poor five year survival rate. Early detection is very important for successful treatment because this tumor is very hard to cure in cases where it has advanced beyond the reach of surgical treatment. The purpose of this review was to evaluate risk factors for carcinoma of the gallbladder and determine the best management approach.. Solitary polys, more than one cm are considered to be predisposing factors for gallbladder carcinoma when they are found to be echopenic, sessile, and with a high cell density. Anomalous union of the pacreato-biliary duct(AUPBD) without a choledochal cyst is also considered to increase risk for gallbladder carcinoma. A polyps size of more than one cm and an AUPBD are indications for prophylactic cholecystectomy. The presence of gallstones is a well-established risk factor for the development of gallbladder carcinoma; risk appears to correlate with the stone size and the duration of chronic cholecystitis. Metaplastic changes of the gallbladder epithelium present with chronic cholecystitis and may indicate a premalignant lesion. Abnormal forms of cholecystitis such as xanthogranulomatous or a porcelain gallbladder also have malignant potential; cholecystoenteric fistula as well as bacterial infection of the gallbladder(typhoid, helicobacter species) also has malignant potential. In this review, the risk factors associated with carcinoma of the gallbladder are summarized with special attention to gallstones, polyps,AUPBD, and chronic inflammation.

Xanthogranulomatous Cholecystitis: Clinical review of 14 cases

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.

Xanthogranulomatous Cholecystitis Mimicking Gallbladder Cancer

We present a case of xanthogranulomatous cholecystitis which involved the liver and clinically mimicked gallbladder carcinoma, and review the associated literature. A 72- year-old woman was admitted to our hospital because of intermittent, right upper quadrant, abdominal pain. Computed tomography showed a large-mass in the gallbladder with findings that seemed to indicate invasion of the liver. During laparotomy, the gallbladder showed signs of chronic cholecystitis, and a cholecystectomy was performed. Histopathological diagnosis was xanthogranulomatous cholecystitis.