Background: Xanthogranulomatous cholecystitis(XGC) is a rare chronic destrucive inflammatory condition of gall bladder, which has characteristic histological findings of multiple intramural nodules, composed of granuloma of lipid-laiden macrophages. As this entity has nonspecific clinical findings of broad spectrum, and almost similar radiologic and gross morphological characteristics with those of advanced gall bladder carcinoma, differential diagnosis is of problem. Occasionally, concomitant gall bladder carcinoma and XGC can be found, and whether XGC is a premalignant condition or not remains to be elucidated. With the increase of aggressive resection of gall bladder cancers even in advaced cases, effort for preoperative differential diagnosis between this entity and gall bladder cancer should be warranted.
Patients and Methods: Retrospective analysis was performed with 27 cases of XGC operated between August 1989 and December 1997 in our department. Clinical features, findings of preoperative imaging studies, operative findings and postoperative courses were reviewed.
Results: Twenety seven cases of XGC were found among 3768 cases of cholecystectomy(0.72 %). Age of patients were distributed in 6th and 7th decades in majority of cases. Most prominent symptom was manifested as right upper quadrant pain(92.6 %) with colicky(56 %) or dull nature(36.6 %). In imaging studies, findings such as, irregular wall thickening of gall bladder, gall stone, and microabscess of gall bladder wall, were noted on ultrasonography or computerized tomography in most of cases. In cases with suspicion of associated malignancy, microabscess within gall bladder wall and low attenuation band around gall bladder wall were most prominent findings for differential diagnosis, indicating benign inflammatory condition. Open cholecystectomy(7) and laparoscopic cholecystectomy(1) were performed in eight cases, diagnosed as benign preoperatively. Two cases of concomitant gall bladder carcinoma were found among them. Among eight cases, preoperatively diagnosed as malignancy, one case of malignancy was found with frozen examination. In two cases of XGC, preoperatively diagnosed as malignancy, revealed to be benign after radical surgery without frozen examination.
Conclusions: In cases of presumed XGC with severe eccentric wall thickening, routine frozen section examination should be requested after complete excision of gall bladder even in the presence of suppurative inflammation which looks alike benign condition. Intraoperative cholagiography may be helpful to rule out concomitant biliary tract neoplasm as well as biliary tract injury especially in tough cases of cholecystectomy for XGC.
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