Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases

Table 1 The clinical presentations n (%)

Variable	No. of patients
Presenting signs and symptoms
Pain	38 (90)
Chronic RUQ pain	26 (61)
Acute RUQ pain, Murphy’s sign (+)	12 (28)
Abdominal distention	20 (48)
Anorexia	19 (45)
Jaundice	9 (21)
High grade fever (> 38  °C)	6 (14)
Nausea and vomiting	5 (12)
RUQ mass	2 (5)
Laboratory findings
Elevated WBC count	11 (26)
Elevated blood bilirubin level	9 (21)
Mild	9 (21)
Moderate	0
Severe	0
Increased CA199 (> 22 U/mL)	32 (76)
Increased CEA (> 4.0 ng/mL)	6 (14)

RUQ: Right upper quadrant; WBC: White blood cell; CEA: Carcinoembryonic antigen.

Table 2 Abdominal computed tomography or magnetic resonance imaging findings n (%)

Finding	No. of patients
Gallstones	22 (52)
Thickened gallbladder wall (> 3 mm)	42 (100)
Diffuse	27 (64)
Focal	15 (36)
Gallbladder distention with pericholecystic fluid	12 (29)
Heterogeneous enhancement of the gallbladder wall	35 (83)
Intramural hypo-attenuated nodules	11 (26)
Pericholecystic infiltration
Blurred liver/gallbladder interface	37 (88)
Abnormal enhancement in hepatic parenchyma neighboring the gallbladder	29 (69)
Infiltration of other adjacent structures	16 (38)
Regional lymph node enlargement	11 (26)

Table 3 Intra-operative findings n (%)

Feature	No. of patients
Thickened gallbladder wall	42 (100)
Adhesions	40 (95)
Omentum	32 (76)
Duodena	16 (38)
Colon	12 (29)
Stomach	8 (19)
Obscure Calot’s triangle anatomy	11 (26)
Gallbladder wall edema	15 (36)
Gangrenous cholecystitis	5 (12)
Gallstones	23 (55)
Combined CBD stones	2 (5)
Mass lesions	12 (29)
Enlarged regional lymph nodes	11 (26)
Gallbladder internal fistula	8 (19)
Mirizzi’s syndrome	4 (10)
Cholecystoduodenal fistula	2 (5)
Gallbladder-transverse colon fistula	2 (5)
Hepatic abscess	3 (7)

CBD: Common bile duct.

Table 4 Comparison of complications for total and subtotal cholecystectomy n (%)

Complication	TC (n = 14)	SC (n = 10)	P value	Significance
Surgical site infection	1 (7)	1 (10)	1.000	NS
Retained stone	0	1 (10)	0.417	NS
Bile duct injury	1 (7)	0	1.000	NS
Duodenal injury	1 (7)	0	1.000	NS
Controlled bile leakage	0	0	-	NS
Biliperitoneum	0	0	-	NS
Hemoperitoneum	0	0	-	NS
Mortality	0	0	-	NS
Morbidity	3 (21)	2 (20)	1.000	NS

TC: Total cholecystectomy; SC: Subtotal cholecystectomy; NS: No significance.

Table 5 Diagnostic accuracy of frozen section analysis in 42 cases of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma

Frozen section diagnosis	Definitive pathological diagnosis
	Cancer	Benign	Total
Cancer	2	0	2
Benign	2	26	28
Total	4	26	30

Sensitivity: 50%; Specificity: 100%; Accuracy: 93%.

Table 6 Accuracy of surgeon’s macroscopic diagnosis of gallbladder carcinoma in 42 cases of xanthogranulomatous cholecystitis

Surgeon’s macroscopic diagnosis	Definitive pathological diagnosis
	Cancer	Benign	Total
Cancer	0	6	6
Benign	0	6	6
Total	0	12	12

Sensitivity: 0; Specificity: 50%; Accuracy: 50%.