Xanthogranulomatous Cholecystitis: Our Clinical Experience
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Keywords

Cholecystectomy
Cholecystitis
Gallbladder
Xanthogranulomatous cholecystitis

How to Cite

Erdogan, O. ., Parlakgumus, A. ., Sozutek, A., Turan, U. ., Abidin Tas, Z., & Irkorucu, O. . (2021). Xanthogranulomatous Cholecystitis: Our Clinical Experience. Iranian Red Crescent Medical Journal, 23(11). https://doi.org/10.32592/ircmj.2021.23.11.1266

Abstract

Background: Xanthogranulomatous cholecystitis (XGC) is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer, and may lead to difficulty in cholecystectomy.

Objectives: This study aimed to review the clinical and radiological findings, as well as surgical treatment results of  XGC.

Methods: This retrospective study analyzed the clinical features of 36 cases with a diagnosis of XGC on pathology. The patients were operated on in our institute between 2012 and 2019.

Results: The rate of  XGC in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over seven years. The patients were aged 33-87 years, and the median age when the patients were diagnosed was 57 years. Moreover, the majority of the patients (52.8%; n=19) were male (male to female ratio: 1/1.11). The XGC was not accompanied by gallbladder carcinoma in any of these cases and could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis, thickening of the gallbladder wall, and suspicious cancer in 29 (80.6%), 28 (77.8%), and 2 (5.6%) patients, respectively. However, none of the cases of  XGC had concomitant gallbladder cancer. In total, 9 (25%) patients underwent open cholecystectomy, and 27 (75%) cases were scheduled to have laparoscopic cholecystectomy; however, 6 (16,8%) of these patients were converted to open cholecystectomy.

Conclusion: Laparoscopic cholecystectomy for XGC is possible; however, it is often difficult due to severe inflammation. Patients with XGC have a higher rate of conversion to open surgery and complications, compared to those with other forms of cholecystitis. The XGC may resemble gallbladder cancer based on the diagnostic imaging findings, and intraoperative frozen section analysis is essential to avoid unnecessarily extended surgery.

https://doi.org/10.32592/ircmj.2021.23.11.1266
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References

1. Park JW, Kim KH, Kim SJ, Lee SK. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc. 2017;31(12):5289-5294. doi: 10.1007/s00464-017-5604-z.

2. Eriguchi N, Aoyagi S, Tamae T, Kanazawa N, Nagashima J, Nishimura K, et al. Xanthogranulomatous cholecystitis. Kurume Med J 2001;48:219-221. doi: 10.2739/kurumemedj.48.219.

3. Guzman-Valdivia G Xanthogranulomatous cholecystitis in laparoscopic surgery. J Gastrointest Surg 2005;9(4):494–497. doi: 10.1016/j.gassur.2004.09.036.


4. Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 1970;90:423–432
5. Güneş Y, Bostancı Ö, İlbar Tartar R, Battal M. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A. 2021;31(1):36-40. doi: 10.1089/lap.2020.0334.

6. Neychev V, Ivanova V, Dikov T, Todorov G. Diffuse Xanthogranulomatous Cholecystitis: Master of Disguise. Cureus. 2018;17;10(4):e2492. doi: 10.7759/cureus.2492.


7. Parra JA, Acinas O, Bueno J, Güezmes A, Fernández MA, Fariñas MC. Xanthogranulomatous cholecystitis: clinical, sonographic, and CT findings in 26 patients. AJR Am J Roentgenol. 2000;174(4):979-83. doi: 10.2214/ajr.174.4.1740979.

8. Singh VP, Rajesh S, Bihari C, Desai SN, Pargewar SS, Arora A. Xanthogranulomatous cholecystitis: What every radiologist should know. World J Radiol. 2016;28;8(2):183-91. doi: 10.4329/wjr.v8.i2.183.


9. Saritas AG, Gul MO, Teke Z, Ulku A, Rencuzogullari A, Aydin I, et al. Xanthogranulomatous cholecystitis: a rare gallbladder pathology from a single-center perspective. Ann Surg Treat Res. 2020;99(4):230-237. doi: 10.4174/astr.2020.99.4.230.

10. Sureka B, Singh VP, Rajesh SR, Laroia S, Bansal K, Rastogi A, Bihari C, et al. Computed Tomography (CT) and Magnetic Resonance (MR) Findings in Xanthogranulomatous Cholecystitis: Retrospective Analysis of Pathologically Proven 30 Cases - Tertiary Care Experience. Pol J Radiol. 2017;22(82):327-332. doi: 10.12659/PJR.901728.


11. Jung SE, Lee JM, Lee K et al. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern. Eur Radiol 2005:15:694–701. doi: 10.1007/s00330-004-2539-2.

12. Makino I, Yamaguchi T, Sato N, Yasui T, Kita I. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false positive result on fluorodeoxy glucose PET. World J Gastroenterol 2009:15(29):3691–3693. doi: 10.3748/wjg.15.3691.


13. Srinivas GN, Sinha S, Ryley N, Houghton PW. Perfidious gallbladders—a diagnostic dilemma with xanthogranulomatous cholecystitis. Ann R Coll Surg Eng 2007:89(2):168–172. doi: 10.1308/003588407X155833.

14. Feng L, You Z, Gou J, Liao E, Chen L. Xanthogranulomatous cholecystitis: experience in 100 cases. Ann Transl Med. 2020;8(17):1089. doi: 10.21037/atm-20-5836.


15. Howard TJ, Bennion RS, Thompson JE Jr. Xanthogranulomatous cholecystitis: a chronic inflammatory pseudotumor of the gallbladder. Am Surg 1991:57(12):821–824

16. Kishore R, Nundy S, Mehrotra S, Metha N, Mangla V, Lalwani S. Strategies for Differentiating Gallbladder Carcinoma from Xanthogranulomatous Cholecystitis-a Tertiary Care Centre Experience. Indian J Surg Oncol. 2017;8(4):554-559. doi: 10.1007/s13193-017-0677-7.


17. Yamagiwa H (1987) Dysplasia of gallbladder. Its pathological significance. Acta Pathol Jpn 1987;7:747–754

18. Yamaguchi K, Enjoji M. Carcinoma of the gallbladder. A clinicopathology of 103 patients and a newly proposed staging. Cancer 1988;62:1425–1432. doi: 10.1002/1097-0142(19881001)62:7<1425::aid-cncr2820620730>3.0.co;2-t.


19. Qasaimeh GR, Matalqah I, Bakkar S, Al Omari A, Qasaimeh M. Xanthogranulomatous cholecystitis in the laparoscopic era is still a challenging disease. J Gastrointest Surg. 2015;19(6):1036-42. doi: 10.1007/s11605-015-2818-z.

20. Takeda Y, Tomimaru Y, Yokota Y, Noguchi K, Noura S, Imamura H, et al. Outcomes of laparoscopic cholecystectomy for xanthogranulomatous cholecystitis. Mol Clin Oncol. 2019;11(3):279-284. doi: 10.3892/mco.2019.1884.


21. Makimoto S, Takami T, Hatano K, Kataoka N, Yamaguchi T, Tomita M, et al. Xanthogranulomatous cholecystitis: a review of 31 patients. Surg Endosc. 2020;27. doi: 10.1007/s00464-020-07828-6.

22. Yucel O, Uzun MA, Tilki M, Alkan S, Kilicoglu ZG, Goret CC. Xanthogranulomatous Cholecystitis: Analysis of 108 Patients. Indian J Surg. 2017;79(6):510-514. doi: 10.1007/s12262-016-1511-0.