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Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases
Tian Yang1, Bai-He Zhang, Jin Zhang
1Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. yangtian6666@hotmail.com
Insights
Xanthogranulomatous cholecystitis (XGC) presents diagnostic challenges, often mimicking gallbladder cancer. Intraoperative frozen-section examination is crucial for accurate diagnosis and appropriate surgical management of XGC.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Xanthogranulomatous cholecystitis (XGC) is a rare, severe form of chronic cholecystitis.
- Characterized by xanthogranulomas, fibrosis, and foam cells, XGC complicates cholecystectomy.
- Often misdiagnosed intraoperatively as gallbladder carcinoma, leading to extensive surgical procedures.
Purpose of the Study:
- To analyze the clinical characteristics of Xanthogranulomatous cholecystitis.
- To identify diagnostic challenges and optimize surgical treatment strategies for XGC.
- To differentiate XGC from gallbladder carcinoma through pathological examination.
Main Methods:
- Retrospective analysis of clinical data from 33 pathologically confirmed Xanthogranulomatous cholecystitis cases over 10 years.
- Preoperative imaging included B-ultrasonography and computed tomography (CT).
- Intraoperative findings and surgical procedures were documented; frozen-section examination was utilized in select cases.
Main Results:
- XGC commonly associated with gallstones (97.0%), gallbladder wall thickening (90.9%), and tissue invasion (87.9%).
- Intraoperative misdiagnosis rate was 24.2%.
- Surgical interventions varied, including open cholecystectomy, partial cholecystectomy, and radical correction for suspected gallbladder cancer.
Conclusions:
- Xanthogranulomatous cholecystitis poses significant diagnostic difficulties preoperatively and intraoperatively.
- Definitive diagnosis relies on pathological examination.
- Intraoperative frozen-section examination is vital for distinguishing XGC from gallbladder carcinoma and guiding surgical decisions.
Background:
Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC.
Methods:
The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5:1).
Results:
Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients.
Conclusions:
XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.
