[Xanthogranulomatous cholecystitis simulating gallbladder neoplasm: therapeutic implications]

Xanthogranulomatous cholecystitis (XGC) is an infrequent type of chronic cholecystitis whose histologic features, in some cases, show a macroscopic appearance which may lead to suspicion of a gallbladder neoplasm with the consequent contraindication of the laparoscopic approach. The incidence of XGC was reviewed in a prospective series of 514 cholecystectomies performed in the authors' department from January 1991 to January 1996. Fourteen cases (2.7%) of XGC were identified with a male/female ratio of 1/1.8 and a mean age of 71 +/- 9 years. The most frequent form of presentation observed was hepatic cholic (43%). Echography showed cholelithiasis in 13 patients (93%). In 3 cases (21%), clinical and echographic suspicion of neoplasm was established, two being in the gallbladder, thus contraindicating the laparoscopic approach. A third patient underwent surgery for suspicion of a colon neoplasm. Xanthogranulomatous cholecystitis presents a macroscopic appearance which may be interpreted as a gallbladder neoplasm in up to 25% of the cases thus leading to treatment with laparoscopy.