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Xanthogranulomatous cholecystitis: a rare gallbladder pathology from a single-center perspective
Ahmet Gokhan Saritas1, Mehmet Onur Gul2, Zafer Teke2
1Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey.
Insights
Diagnosing xanthogranulomatous cholecystitis (XGC) is challenging preoperatively. Definitive diagnosis of XGC relies solely on pathological examination, highlighting the need for advanced imaging techniques.
Area of Science:
- Gastroenterology
- Pathology
- Radiology
Background:
- Xanthogranulomatous cholecystitis (XGC) is a rare, chronic inflammatory condition of the gallbladder.
- It can mimic gallbladder cancer clinically and radiologically.
Purpose of the Study:
- To review the clinical and pathological features of xanthogranulomatous cholecystitis (XGC).
- To evaluate the diagnostic challenges of XGC.
Main Methods:
- Retrospective review of 79 patients diagnosed with XGC.
- Analysis of histopathological criteria including histiocytes, cholesterol deposits, and lipids.
- Review of imaging findings from computed tomography (CT) and magnetic resonance imaging (MRI).
Main Results:
- The study included 79 patients (65.8% male, 34.2% female) with a mean age of 65.8 years.
- Abdominal pain was the most common symptom (63.3%); jaundice was least common (8.9%).
- Imaging showed gallbladder wall thickening in over 80% of cases, with suspicion of malignancy often reported but not confirmed.
Conclusions:
- Preoperative and intraoperative diagnosis of XGC is difficult.
- Advanced imaging beyond ultrasonography is needed for preoperative assessment.
- Definitive diagnosis of XGC is exclusively dependent on histopathological examination.
Purpose:
The aim of this study was to review patients with xanthogranulomatous cholecystitis (XGC).
Methods:
A total of 79 patients diagnosed with XGC were included in the study. The criteria for XGC in the pathology specimens were the presence of histiocytes, cholesterol deposits, lipids, and focal or widespread wall enlargement.
Results:
Patients were diagnosed with XGC, of which 52 (65.8%) were male and 27 (34.2%) were female, creating a male-to-female ratio of 2:1. The mean age was 65.8 ± 14.3 years (range, 36-97 years). The most common presenting symptom was abdominal pain (63.3%), and the least common presenting symptom was jaundice (8.9%). Of the total, 25 patients were found to have pathological conditions with the potential to obstruct the bile duct or to slow bile flow. A frozen section examination was performed on 20 patients due to suspicion of a tumor by intraoperative macroscopic examination. However, no malignancy was detected in the cases who underwent a frozen section examination. An increase in wall thickness of the gallbladder was observed in 81.6% (n = 31) of the patients on computed tomography scans and in 81.8% (n = 18) of the patients on magnetic resonance imaging scans in which possible tumor lesions were reported, but no tumor was detected.
Conclusion:
It is difficult to diagnose XGC either preoperatively or intraoperatively, and further imaging methods are needed in the preoperative period other than ultrasonography. However, a definitive diagnosis depends exclusively on pathologic examination.
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