Xanthogranulomatous Cholecystitis: A Retrospective Analysis of 36 Cases

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.