Xanthogranulomatous Cholecystitis Presenting as Empyema Gallbladder in Patient of Chronic Cholecystitis with Cholelithiasis

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.

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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.

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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

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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.

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A 3 YEARS HISTOPATHOLOGICAL STUDY OF GALLBLADDER AFTER CHOLECYSTECTOMY IN A TERTIARY CARE HOSPITAL

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.885 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

M. Reeta Devi ◽

L. Nabina ◽

R.K. Ronal

Keyword(s):

Tertiary Care Hospital ◽

Histopathological Examination ◽

Tertiary Care ◽

Chronic Cholecystitis ◽

Common Disease ◽

Histopathological Diagnosis ◽

Care Hospital ◽

Xanthogranulomatous Cholecystitis ◽

Incidental Diagnosis ◽

Wide Range

Background: Diseases of the gallbladder are pretty common. Most of the cases admitted in hospitals required surgical intervention and removal. Histopathological routine examination of the resected gallbladder shows a wide range of changes, from inflammatory to different variants and from premalignant to malignancy. This study is undertaken to find the changes in the cholecystectomy specimen along with their gender and age distribution. Methods: The present retrospective study was conducted in the cholecystectomy specimen received in the department of Pathology, Regional Institute of Medical Sciences (RIMS), a tertiary care hospital during the period of January 2014 to December 2016. The corresponding blocks are retrieved from the archives of the department, sections are cut and slides are stained with Hematoxylin and Eosin stain,Three representative slides of each specimen are examined. The aim of this study is to analyse the different histopathological changes of the gallbladder and their distribution in different age groups and as well as in gender. Results: A total of 1506 cholecystectomy specimen were received in the histopathology section of the department. Out of which, 1282 cases (85.12%) were females while 224 cases (14.88%) were male patients. Female to male ratio is 6:1. The most common histopathological diagnosis of cholecystectomy specimen was chronic cholecystitis followed by chronic cholecystitis with focal evidence of cholesterolosis and xanthogranulomatous cholecystitis. There were 3 cases of incidental diagnosis of adenocarcinoma gallbladder. Conclusion: Chronic cholecystitis is the most common disease affecting the gallbladder which with a high rate of occurance all over the world. The study firmly recommends thorough histopathological examination of all resected gallbladder. Incidental diagnosis of adenocarcinoma further warrents the need for thorough histopathological examination to help in treatment and prognosis. Keywords: Chronic cholecystitis, cholesterolosis, xanthogranulomatous cholecystitis, incidental adenocarcinoma.

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Xanthogranulomatous cholecystitis complicated by a cholecysto-colonic fistula and liver abscesses†

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa176 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Nolitha Morare ◽

Lwazi Mpuku ◽

Zain Ally

Keyword(s):

Chronic Cholecystitis ◽

Unusual Complication ◽

Xanthogranulomatous Cholecystitis ◽

Quadrant Pain ◽

Colonic Fistula ◽

Liver Abscesses ◽

Cholecystoenteric Fistula ◽

Biliary Sepsis ◽

Xanthogranulomatous Inflammation ◽

Biliary Pathology

Abstract A 57-year-old male presented to the emergency department with right upper quadrant pain and constitutional symptoms. Initial investigation revealed biliary sepsis with features of chronic cholecystitis, multiple liver abscesses and a fistulous connection between the gallbladder and colon. He was subsequently diagnosed with a cholecysto-colonic fistula, an unusual complication of biliary pathology, with an incidence of 0.06–0.14% at cholecystectomy. It is the second most common form of cholecystoenteric fistula, the first of which is cholecystoduodenal. A preoperative diagnosis was suggested using computed tomography and sinogram imaging. The associated liver abscesses together with the xanthogranulomatous inflammation found on histopathology, makes the case particularly exceptional.

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A case report of Xanthogranulomatous Cholecystitis

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v5i1.166 ◽

2021 ◽

Vol 5 (1) ◽

pp. 813-818

Author(s):

Ahmed Hassan Abdelmoneim ◽

Adham Darweesh ◽

Avin Kounsal ◽

Abdelwahed Samir Abougazia

Keyword(s):

Case Report ◽

Inflammatory Disease ◽

Transverse Colon ◽

Inflammatory Process ◽

Plasma Cells ◽

Chronic Cholecystitis ◽

Xanthogranulomatous Cholecystitis ◽

Significant Morbidity ◽

Muscular Layer ◽

Female Predominance

Xanthogranulomatous cholecystitis is a benign, uncommon type of chronic cholecystitis manifested by focal or diffuse severe inflammatory process of the gallbladder (GB). It is inflammatory disease of the gallbladder characterized by the infiltrations of plasma cells, lipid-laden histiocytes, and the fibroblasts proliferation in GB wall. Gallstones are present in all patients, and like most symptomatic gallbladder diseases, there is a female predominance. It is an active inflammatory process which could leads to significant morbidity. The term Xanthogranulomatous cholecystitis was initially proposed by Goodman and Ishak in 1981. The pathogenesis of XGC is the rupture of Rokitansky-Aschoff sinuses and extravasation of bile into the muscular layer. The rupture of the serosa results in adhesion to the adjacent liver, duodenum, and transverse colon. Macroscopically, it appears like yellowish masses in the wall of the GB. Radiologically it is an important mimic of gallbladder carcinoma.

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