Differences between xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: an 11-year retrospective study

Xanthogranulomatous cholecystitis (XGC) is a benign yet locally aggressive inflammatory condition that often mimics gallbladder adenocarcinoma (GBC) in clinical, radiological, and intraoperative presentation, leading to diagnostic uncertainty and potential overtreatment. This retrospective study aimed to identify distinguishing features between XGC and GBC by analyzing demographic, clinical, biochemical, radiological, and histopathological data from 133 patients who underwent cholecystectomy between 2013 and 2024. Among them, 115 were diagnosed with XGC and 18 with GBC. Gallbladder wall thickness ≥ 7.5 mm was identified as the most powerful predictor of malignancy, demonstrating 94.4% sensitivity, 84.3% specificity, and a 99% negative predictive value. Additional parameters associated with GBC included advanced age (≥ 65.5 years), anemia (hemoglobin ≤ 11.45 g/dL), thrombocytopenia (platelet count ≤ 215 × 10⁹/L), and mild hyponatremia (sodium ≤ 137.5 mmol/L), though their individual diagnostic performance was limited. Gallbladder polyps were significantly more prevalent in GBC cases. While conversion to open surgery was frequent in both groups due to technical complexity, it was not significantly different. These findings highlight the critical role of gallbladder wall thickness as a non-invasive, reliable diagnostic marker, particularly when combined with patient age and laboratory indicators. Incorporating these parameters into the preoperative assessment may improve diagnostic accuracy, reduce unnecessary radical procedures in benign conditions such as XGC, and facilitate timely intervention in malignancy.