Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: an analysis of 42 patients

Objective To study the clinical features of xanthogranulomatous cholecystitis (XGC), and to analyze the difficulties in the differential diagnosis of XGC with gallbladder carcinoma. Methods The clinical data of 42 patients who were diagnosed preoperatively as gallbladder cancer in our hospital from 2008 to 2016 were retrospectively analyzed. Results Of the 42 patients, upper abdominal CT scans were carried out in 38 patients, and MRI examination in 4 patients. Imaging findings showed unclear boundaries between the liver and the gallbladder in 37 patients, and unclear boundaries between the gallbladder and the adjacent tissues in 16 patients. In 11 patients, the regional lymph nodes were enlarged. 22 patients had gallstones. All the 42 patients had gallbladder wall thickness of ≥3 mm. In 27 patients there were diffuse thickenings of the gallbladder wall, while in 15 patients there were only local thickenings. In 35 patients, inhomogeneous enhancement of the gallbladder wall was shown on CT enhancement scanning, and in 11 patients, there were low attenuation nodules in the gallbladder wall. All the 42 patients underwent surgical treatment. During surgery, dissection of the gallbladder triangle was difficult because of dense adhesion of the gallbladder with the surrounding tissues. In 32 patients, the gallbladder was adherent to the omentum, in 16 patients to the duodenum, in 12 patients to the colon, and in 8 patients to the stomach. In 30 patients, intraoperative frozen sections were carried out. Two patients were diagnosed to have early gallbladder cancer (T1a GBC). In 12 patients who did not receive frozen section during operation, 6 patients were subsequently diagnosed to have XGC and 6 patients to have gallbladder cancer. The types of surgical treatment given to these patients were according to the intraoperative diagnosis or frozen sections results. After surgery, one patient each developed surgical site infection in the total cholecystectomy group as well as in the partial cholecystectomy group. In addition, one patient had bile duct injury and another patient had duodenal injury in the total cholecystectomy group. There was one patient who had residual biliary stone in the partial cholecystectomy group. The difference in the postoperative complication rates between the two groups was not significant (P>0.05). Conclusions It is difficult to differentiate XGC from gallbladder cancer based on clinical and imaging findings. The final diagnosis still depends on histopathological examination. Key words: Xanthogranulomatous cholecystitis; Gallbladder carcinoma; Intraoperative frozen-section; Pathology