Extended resection for xanthogranulomatous choleystitis mimicking gallbladder carcinoma: review of cases and diagnostic approach

Abstract

Background: Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis which may involve adjacent organs including liver, colon and duodenum mimicking gallbladder cancer. Preoperative differentiation of xanthogranulomatous cholecystitis from gallbladder cancer is often difficult and the final diagnosis is usually made on histopathology of the resected specimen. Methods: We report four cases of xanthogranulomatous cholecystitis which were misdiagnosed as cases of advanced gallbladder cancer based on presentation and radiological findings. Results: All the four patients presented with history of upper abdominal pain while two patients had history of associated weight loss. Radiological features were strongly suggestive of gallbladder cancer with involvement of adjacent organs in all cases. Based on the imaging findings, these patients underwent radical resections but the final histopathology was a diagnostic surprise. Conclusion: Xanthogranulomatous cholecystitis is still a diagnostic challenge as no clinical and imaging modality has been helpful to make a definitive diagnose of this entity. We review the role of available diagnostic modalities in this challenging area of uncertainty. Radical resection may be justified in patients who present with the features mimicking gallbladder cancer.