Strategies for Differentiating Xanthogranulomatous Cholecystitis From Gall Bladder Carcinoma – A Tertiary Care Centre Experience

Samiran Nundy, MCh, MA, FRCP, FRCS1, Kishore Rajaguru, MBBSMSDNBMRCSEdFMASDMAS2. 1sir gangaram hospitals and research institute, new delhi, India, 2ng teng fong general hospital . singapore

AIM:  Xanthogranulomatous cholecystitis (XGC) mimics Gallbladder carcinoma (GBC) in both preoperative and intra-operative setting and the patient may undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy which is associated with a greater morbidity and mortality. We postulated that a pre-operative diagnosis of XGC might benefit patients by avoiding radical procedures and attempted to identify the features of XGC which differentiate it from GBC before and during surgery.

METHODS:  All the patients who underwent Gall bladder related operations (benign and malignant), over a period of 5 years from 2010 to 2014 were reviewed in a tertiary centre hospital in India. Out of these patients, histopathological reports of XGC were placed in a Group A and GB malignancies were included in GROUP B. The following parameters are recorded – clinical features, biochemical, radiological findings including the presence of gall stones/common bile duct (CBD) stones, focal or diffuse wall thickening of the GB, the presence of intramural bands or nodules in the wall, lymph node enlargement, mucosal enhancement, and the status of the interface between the liver bed and gall bladder and a comparison was made between the groups.

RESULTS:  Patients with a long history of recurrent abdominal pain and who on imagingare found to have a diffusely thickened gall bladder wall, with cholelithiasis, choledocholithiasis, and submucosal hypo attenuated nodules are likely to have XGC while those with anorexia, weight loss, focal thickening of the gallbladder wall on imaging and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of a fat plane interface between the liver and gallbladder are not differentiating factors. However the definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.

CONCLUSION:  The differentiation of XGC and GBC pre-operatively remains a challenge. However the definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.

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