Xanthogranulomatous cholecystitis: still a diagnostic dilemma-our experience

Abstract

Introduction: Aims of our study -To assess whether xanthogranulomatous cholecystitis can be diagnosed based on clinical presentation and radiological findings --Is intra operative frozen section enough to label xanthogranulomatous cholecystitis vis a vis co existing carcinoma Materials and methods: A retrospective review of clinical record of 732 consecutive patients who underwent laparoscopic/open cholecystectomy during the period of 4 years from October 2013 to November 2017. Result and discussion: Out of 732 procedures performed there were 34 cases of xanthogranulomatous cholecystitis. There were 2 cases of simultaneous gall bladder cancer with XGC. In one case of XGC reported on frozen section the final histopathology revealed carcinoma gallbladder with presence of XGC. The other case revealed carcinoma gallbladder on frozen section and on final histopathology, there was presence of XGC with carcinoma gallbladder. The incidence of XGC was 4.5%. The mean age of presentation was 52.1 years with a female to male ratio 1.6:1. Most common symptom was abdominal pain (96%) followed by jaundice (15%) and fever (15%), weight loss, anorexia present and palpable RUQ mass present in 3.12% of patients.Abdominal CECT revealed focal wall thickness in 16% and diffuse wall thickness in 60% of patients. Hepatic and pericholecystic infiltration was present in 12% of patients with 84% had associated cholelithiasis. Conclusions: The diagnosis of xanthogranulomatous cholecystitis is only confirmed on histopathology. The clinical presentation is unequivocal in most cases. The intraoperative frozen section may help in planning the radical surgery but the final histopathology may reveal a co existing cancer.