Xanthogranulomatous Cholecystitis

ABSTRACT

Xanthogranulomatous cholecystitis(XGC) is a rare, benign, destructive, inflammatory process of the gallbladder that is believed to be a variant of chronic cholecystitis. The gross and microscopic appearances are characteristic with multiple intramural nodules composed of foamy histiocytes and inflammatory cells. Clinically, radiologically and morphologically, XGC sometimes is confused with a malignant neoplasm. In a retrospective twelve year study, 20 cases of XGC were found in 2007 gallbladders (0.99%) and we have been reviewed the characteristic features of it. In 8 patients(40%) XGC sufficiently resembled carcinoma of the gallbladder for the radiological study and surgeon. Gallstones were found in 14 cases(70%). Associated malignancy were 2 cases : one in distal CBD and one in head of pancreas but, there was no coexisted carcinoma of the gallbladder. Complete cholecystectomy was done in 12 cases(60%) and partial cholecystectomy was performed in 7 cases(35%). One underwent T-tube choledochostomy only for suspectd carcinoma of the gallbladder, which subsequently proved to be XGC. In conclusion, appearances often mimicked carcinoma of the gallbladder at laparotomy with xanthogranulomatous tissue extending to adjacent structures. So the possibility should be considered that an `inoperable tumor' of the gallbladder may be in fact XGC, a benign condition that frozen-section biopsy may confirm. If XGC was suspected at operation or confirmed at frozen-section biopsy, coincident carcinoma may still be present. Management of XGC should therefore include choloecystectomy and excision of adjacent xanthogranulomatous tissue and any fistula.