Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12653-12659
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12653
Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases
Yi-Lei Deng, Nan-Sheng Cheng, Shui-Jun Zhang, Wen-Jie Ma, Anuj Shrestha, Fu-Yu Li, Fei-Long Xu, Long-Shuan Zhao
Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Nan-Sheng Cheng, Wen-Jie Ma, Anuj Shrestha, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
Author contributions: Deng YL, Cheng NS and Zhao LS designed the research; Deng YL, Zhang SJ, Ma WJ and Zhao LS performed the research; Shrestha A, Li FY and Xu FL contributed new reagents or analytic tools; Deng YL, Zhang SJ, Ma WJ and Zhao LS analyzed the data; Deng YL, Cheng NS and Shrestha A wrote the paper.
Supported by The Science and Technology Support Project of Sichuan Province, No. 2014SZ0002-10.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou 450000, Henan Province, China. dengyilei@163.com
Telephone: +86-371-66913114 Fax: +86-371-66916261
Received: January 2, 2015
Peer-review started: January 13, 2015
First decision: January 22, 2015
Revised: August 26, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: November 28, 2015
Processing time: 328 Days and 16.2 Hours
Abstract

AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically.

METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed.

RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon’s macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon’s macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05).

CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.

Keywords: Xanthogranulomatous cholecystitis; Gallbladder carcinoma; Frozen-section analysis; Cholecystectomy

Core tip: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that could mimic gallbladder carcinoma (GBC) in various ways. The aim of this study was to review and evaluate the diagnostic dilemma of XGC clinically. We concluded that neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC. For XGC with suspected GBC, intra-operative frozen section analysis should be performed, and the benign diagnosis indicates that a simple cholecystectomy is appropriate. However, the final diagnosis still depends on the pathology.