Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: retrospective analysis of 10 cases

Abstract

To investigate the reasons for misdiagnosing xanthogranulomatous cholecystitis (XGC) as gallbladder carcinoma, and to provide differential points between these two diseases. Thirty-three patients with the final diagnosis of XGC in our hospital over a period of 10 years (1996-2005) were reviewed, among which 10 (6 males and 4 females) were misdiagnosed as having gallbladder carcinoma either preoperatively or intraoperatively. 10 misdiagnosed cases were examined preoperatively by B-ultrasound (BUS) and computed tomography (CT). BUS and CT revealed 5 cases of gallbladder carcinoma and 1 of chronic cholecystitis; 2 cases were diagnosed as gallbladder carcinoma on BUS but chronic cholecystitis on CT; other 2 cases were diagnosed as chronic cholecystitis on BUS but as gallbladder carcinoma on CT. Intraoperatively, thickening of the gallbladder wall was found in all of the patients; xanthogranulomatous tissue was found invading into other tissues including gallbladder bed and omentum majus. Intraoperative frozen section investigation was performed on 1 patient revealing that no tumor cell was found. Open cholecystectomy + partial hepatic wedge resection were performed on 3 patients; cholecystectomy + partial hepatic wedge resection + regional lymphadenectomy in the liver duodenum ligament on 6 patients; cholecystectomy + cholecystoenterostomy + colocolic anastomosis after partial resection of transverse colon on 1 patient. Postoperative pathological findings revealed XGC in all these patients. XGC is an uncommon variant of chronic cholecystitis of which clinical and imaging presentations closely resemble gallbladder carcinoma. Thus differentiation is essential by means of intraoperative frozen section investigation to ensure optimal surgical treatment since XGC has its pathological distinctions, which are not that of a precancerous change.