Xanthogranulomatous cholecystitis: Difficulty in differentiating from gallbladder cancer

Figure 1 Computed tomography scan revealing a large mass and stone (arrow) with suspected hepatic invasion (A) and asymmetric thickened gallbladder wall with homogeneous enhancement of a continuous mucosal line and submucosal hypoattenuated nodule (arrow) (B).

Figure 2 Fluorodeoxyglucose positron emission tomography showing abnormal accumulation in the hepatic hilum (SUVmax = 10. 2).

Figure 3 Histology of the gallbladder mucosa showing hyperplasia (A), HE × 200; the adjacent liver showing diffuse inflammatory infiltrate consisting of giant histiocytes and foamy histiocytes with clear lipid-containing cytoplasm, lymphocytes, and polymorphonuclear cells (B), HE × 400.

Figure 4 ERC revealing a filiform stenosis of the proximal common bile duct and bifurcation. ERC: Endoscopic retrograde cholangiography.

Figure 5 Computed tomography scan revealing a hypodense mass at the hilum (A) and intrahepatic bile duct dilatation due to the tumor (B).

Figure 6 Fluorodeoxyglucose positron emission tomography showing abnormal accumulation at the hepatic hilum (SUVmax = 5. 2).

Figure 7 Microscopic examination revealing a gallbladder wall markedly thickened with severe inflammation and fibrosis (A), HE × 200; Large xanthoma cell with clear-to-foamy lipid-containing cytoplasm and interspersed lymphocytes invading the liver (B), HE × 400.