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• W2004268797 abstract "Question: A 65-year-old woman presented to us with complain of pain in right hypochondrium for 2 months. There was no other contributory history. The fundus of the gallbladder was just palpable per abdomen. Her liver function tests and other hematologic investigations were within normal range. Abdominal ultrasonography was highly suggestive of gallbladder perforation. She underwent abdominal computed tomography, which showed the presence of impacted stone in neck of gallbladder with features of contained perforation of gallbladder also noted was the dilatation of the common bile duct. However, in view of the age of the patient a differential diagnosis of gallbladder malignancy was also suggested (Figure A). The patient's CA19-9 and CEA levels were normal. Because she was clinically stable, we planned exploratory laparotomy. She underwent an open cholecystectomy with 2-cm wedge resection of the liver (Figures B and C). What is the final diagnosis? Look onpage 1539for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. On frozen section, the liver resection margin showed no evidence of malignancy. The final histology was suggestive of xanthogranulomatous cholecystitis (Figure D). Xanthogranulomatous cholecystitis is a rare inflammatory disease of the gallbladder characterized by a focal or diffuse destructive inflammatory process, with accumulation of lipid laden macrophages, fibrous tissue, and acute and chronic inflammatory cells.1Jessurun J. Albores-Saavedra J. Gallbladder and extrahepatic biliary ducts.in: Damjanov I. Linder J. Anderson's Pathology. CV Mosby, St Louis1996: 1859Google Scholar Initially known by the descriptive term fibroxanthogranulomatous cholecystitis, in 1981, it was changed to xanthogranulomatous cholecystitis. It comprises 0.7%–13.2% of gallbladder disease, affecting mainly women in the 6th and 7th decades of life.2Parra J.A. Acinas O. Bueno J. et al.Xanthogranulomatous cholecystitis Clinical, sonographic and CT findings in 26 patients.AJR. 2000; 174: 979-983Crossref PubMed Scopus (105) Google Scholar Its significance lies in the fact that it is a benign condition that may be confused with carcinoma of the gallbladder, which is associated with a poor prognosis. Xanthogranulomatous cholecystitis was initially described as a variant of chronic cholecystitis. However, although the latter is usually regarded as a benign condition, xanthogranulomatous cholecystitis is an active and destructive process that can lead to significant morbidity; the inflammatory process usually extends into the gallbladder wall and adjacent structures. Thus, it should be considered a distinct clinical entity. The pathogenesis of xanthogranulomatous cholecystitis is thought to be related to extravasation of bile into the gallbladder wall from rupture of Rokitansky-Aschoff sinuses or by mucosal ulceration. This event incites an inflammatory reaction in the interstitial tissue whereby fibroblasts and macrophages phagocytose the biliary lipids in bile, such as cholesterol and phospholipids, leading to the formation of xanthoma cells. Gallstones may have an important role in the pathogenesis; they seem to be present in all patients.3Dixit V.K. Prakash A. Gupta A. et al.Xanthogranulomatous cholecystitis.Dig Dis Sci. 1998; 43: 940Crossref PubMed Scopus (75) Google Scholar Xanthogranulomatous cholecystitis is considered analogous to xanthogranulomatous pyelonephritis, which results from obstruction and stasis owing to renal calculi. Clinical features and laboratory investigations are similar to any other gallbladder disorder. On abdominal ultrasonography and computed tomography, the presence of hypoechoic nodules or bands in a thickened gallbladder wall, along with presence of calculi, is highly suggestive of xanthogranulomatous cholecystitis.2Parra J.A. Acinas O. Bueno J. et al.Xanthogranulomatous cholecystitis Clinical, sonographic and CT findings in 26 patients.AJR. 2000; 174: 979-983Crossref PubMed Scopus (105) Google Scholar Treatment is cholecystectomy and final diagnostic confirmation is always by histopathology." @default.
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• W2004268797 date "2009-10-01" @default.
• W2004268797 modified "2023-10-16" @default.
• W2004268797 title "Is Imaging the Ultimate Answer for All Gallbladder Pathology?" @default.
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• W2004268797 doi "https://doi.org/10.1053/j.gastro.2009.06.058" @default.
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