Averting Unnecessary Radical Surgery: Xanthogranulomatous Cholecystitis Mimicking Gallbladder Carcinoma

Xanthogranulomatous cholecystitis (XGC) is a rare, benign inflammatory condition that closely mimics gallbladder carcinoma clinically, radiologically, and intraoperatively. We present the case of an elderly Indian man in his 80s with multiple comorbidities, with vomiting and anorexia, whose radiological and positron emission tomography-computed tomography (PET-CT) findings showed a fluorodeoxyglucose (FDG)-avid gallbladder mass with extension into the liver, cystic duct, common hepatic duct, and common bile duct, highly suggestive of gallbladder carcinoma. However, histopathological examination confirmed XGC. Conservative management with follow-up PET-CT imaging showed marked resolution of FDG uptake, supporting the benign inflammatory nature of the disease. This case shows that FDG avidity does not necessarily indicate malignancy and highlights the indispensable role of histopathological confirmation before considering radical surgery. XGC should be considered in the differential diagnosis of gallbladder masses and FDG-avid lesions to avoid misdiagnosis and unnecessary radical surgery, especially in elderly comorbid patients.