Heterogenous wall thickening of gall blabber: xanthogranulomatous cholecystitis or carcinoma, with type 3 choledochal cyst

Background Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis. The differential diagnoses of XGC include gallbladder cancer (GBC), adenomyomatosis, and actinomycosis of the gallbladder. Purpose To assess the usefulness of computed tomography (CT) findings in the diagnosis of XGC and differentiation from GBC. Material and Methods We retrospectively assessed the pathological and radiological records of 13 patients with pathologically proven XGC and 33 patients with GBC. Results Significant differences were observed for the following five CT findings: diffuse wall thickening (XGC = 85%, GBC = 15%, P < 0.01); absence of polypoid lesions (XGC = 100%, GBC = 48%, P < 0.01); intramural nodules or bands (XGC = 54%, GBC = 9%, P < 0.01); pericholecystic infiltration (XGC = 69%, GBC = 9%, P < 0.01); and pericholecystic abscess (XGC = 23%, GBC = 0%, P = 0.018). We defined the scoring system based on how many of the five CT findings were observed. Our scoring system, which included these findings, revealed that patients with three or more findings had sensitivity of 77% (95% confidence interval [CI] = 57–87) and specificity of 94% (95% CI = 86–98). Conclusion Our scoring system can assist in the differentiation of XGC from GBC.

Download Full-text

A Rare Finding During a Common Procedure: Xanthogranulomatous Cholecystitis

International Surgery ◽

10.9738/intsurg-d-13-00094.1 ◽

2014 ◽

Vol 99 (5) ◽

pp. 595-599 ◽

Cited By ~ 1

Author(s):

Fatih Taskesen ◽

Zulfu Arikanoglu ◽

Omer Uslukaya ◽

Abdullah Oguz ◽

Ibrahim Aliosmanoglu ◽

...

Keyword(s):

Open Surgery ◽

Early Stage ◽

Chronic Cholecystitis ◽

Pathological Examination ◽

Wall Thickening ◽

Xanthogranulomatous Cholecystitis ◽

Common Procedure ◽

History Of ◽

Difficult Cholecystectomy ◽

Destructive Inflammation

Abstract Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.

Download Full-text

Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution

Kathmandu University Medical Journal ◽

10.3126/kumj.v6i4.1738 ◽

1970 ◽

Vol 6 (4) ◽

pp. 472-475 ◽

Cited By ~ 8

Author(s):

PBS Kansakar ◽

G Rodrigues ◽

SA Khan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Preoperative Diagnosis ◽

Open Cholecystectomy ◽

Bladder Wall ◽

Tertiary Care ◽

Chronic Cholecystitis ◽

Clinical Aspects ◽

Wall Thickening ◽

Xanthogranulomatous Cholecystitis

Background: Xanthogranulomatous cholecystitis is an unusual and destructive form of chronic cholecystitis and is indistinguishable from other forms of cholecystitis which makes preoperative diagnosis and surgery difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult surgery. Materials and methods: All cases histopathologically diagnosed as xanthogranulomatous cholecystitis over a period of six years from October 1999 to September 2005 at Kasturba Medical College Hospital, Manipal, India were included in the study. Data of the patients was collected retro and prospectively. Results: A total of 615 patients underwent cholecystectomy out of which 33 (5.2%) were diagnosed to have xanthogranulomatous cholecystitis. Ultrasound abdomen showed gallbladder wall thickening in 19 (57.5%) cases and gallstones in 32 (96.9%) cases. Thirty (90.9%) underwent open cholecystectomy. Gallbladder could be removed totally in 25 (75.6%) cases whereas five (15.2%) had to undergo partial cholecystectomy and in one patient, only cholecystostomy could be performed due to dense adhesions. Laparoscopic cholecystectomy was attempted in 11 patients but successful only in two patients with a conversion rate of 81.8%. Postoperative wound infection was seen in five (15.1%) patients and one (3%) had minor biliary leak which was treated conservatively. Histologically, xanthogranulomatous cholecystitis was associated with malignancy in one (3.03%) patient. There was no mortality. Conclusion: Clinical presentation of xanthogranulomatous cholecystitis was indistinguishable from chronic cholecystitis. Ultrasonography may reveal only non specific findings of calculi and thickened gall bladder wall. Hence preoperative diagnosis is unlikely. Cholecystectomy was usually difficult owing to dense adhesions of gallbladder and Calot's triangle. Conversion rate of laparoscopic cholecystectomy is higher. Morbidity associated with surgery is significant. Key words: Xanthogranulomatous cholecystitis, Cholecystectomy, Malignancy doi: 10.3126/kumj.v6i4.1738 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 472-475

Download Full-text

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?

Gastroenterology Research and Practice ◽

10.1155/2014/253645 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Ashwin Rammohan ◽

Sathya D. Cherukuri ◽

Jeswanth Sathyanesan ◽

Ravichandran Palaniappan ◽

Manoharan Govindan

Keyword(s):

Gallbladder Cancer ◽

Preoperative Diagnosis ◽

Histopathological Examination ◽

Radical Resection ◽

Gallbladder Wall ◽

Wall Thickening ◽

Xanthogranulomatous Cholecystitis ◽

Radiological Features ◽

Group A ◽

Group B

Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC.Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC.Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases.Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.

Download Full-text

Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: Added value of diffusion-weighted MRI

Clinical Radiology ◽

10.1016/j.crad.2013.03.022 ◽

2013 ◽

Vol 68 (10) ◽

pp. 992-1001 ◽

Cited By ~ 31

Author(s):

T.W. Kang ◽

S.H. Kim ◽

H.J. Park ◽

S. Lim ◽

K.M. Jang ◽

...

Keyword(s):

Gallbladder Cancer ◽

Added Value ◽

Wall Thickening ◽

Diffusion Weighted Mri ◽

Xanthogranulomatous Cholecystitis ◽

Diffusion Weighted

Download Full-text

Histological evaluation of 400 cholecystectomy specimens

Journal of Pathology of Nepal ◽

10.3126/jpn.v5i10.15640 ◽

2015 ◽

Vol 5 (10) ◽

pp. 834-840 ◽

Cited By ~ 1

Author(s):

H Kumar ◽

H Kini ◽

A Tiwari

Keyword(s):

Acute Cholecystitis ◽

Choledochal Cyst ◽

Chronic Cholecystitis ◽

Histological Evaluation ◽

P Value ◽

Kasturba Medical College ◽

Xanthogranulomatous Cholecystitis ◽

Medical College ◽

Number Of Patients ◽

Common Diagnosis

Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007) received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25%) being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%), followed by chronic active cholecystitis (20.25%), acute cholecystitis (6%), gangrenous cholecystitis (2.25%),xanthogranulomatous cholecystitis (0.50%), empyema (1%), mucocele (0.25%), choledochal cyst (0.25%), adenocarcinoma gallbladder (1.25%) and normal gallbladders (1%).Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25%) cases, and significantly associated with various lesions (P value 0.009). Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate sectioning is mandatory in all cases to assess epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.

Download Full-text

Distinguishing Xanthogranulomatous Cholecystitis from the Wall-Thickening Type of Early-Stage Gallbladder Cancer

Gut and Liver ◽

10.5009/gnl.2010.4.4.518 ◽

2010 ◽

Vol 4 (4) ◽

pp. 518-523 ◽

Cited By ~ 32

Author(s):

Byung Jin Chang ◽

Seong Hyun Kim ◽

Ho Yong Park ◽

Seong Woo Lim ◽

Jeong Kim ◽

...

Keyword(s):

Gallbladder Cancer ◽

Early Stage ◽

Wall Thickening ◽

Xanthogranulomatous Cholecystitis

Download Full-text

Scanning Electron Microscopy of the Red Pulp of the Spleen

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010006653x ◽

1971 ◽

Vol 29 ◽

pp. 496-497

Author(s):

Masayuki Miyoshi

Keyword(s):

Electron Microscope ◽

Ringer Solution ◽

Conclusive Evidence ◽

Sinus Wall ◽

Transmission Electron ◽

Type 3 ◽

Cytoplasmic Processes ◽

Splenic Red Pulp ◽

Scanning Electron ◽

Red Pulp

In spite of various attempts, conclusive evidence to explain blood passage in the splenic red pulp does not seem to have been presented. Scanning electron microscope (SEM) observations on the rabbit spleen, originally performed by us, revealed that the sinus was lined by a perforated lattice composed of longitudinally extended rod cells and transverse cytoplasmic processes, and that perforations in the lattice were continuous to the spaces among the stellate reticulum cells of the cord. In the present study the observation was extended to the dog and rat spleens, in which the cord is more developed than in the rabbit in order to clarify the possible differences in the fine structure of the sinus wall. An attempt was also made to examine the development and distribution of macrophage in the blood passage of the red pulp.Spleens were washed and fixed by perfusion with Ringer solution and then with buffered glutaraldehyde. Small tissue cubes were dehydrated with acetone, dried in air and heated with gold. Observations were made by a JEOL SEM Type-3. One air dried tissue cube was cut into small pieces and post fixed with buffered OsO4 for examination under the transmission electron microscope (TEM).

Download Full-text