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Reddy KP, Gupta P, Gulati A, Singh T, Kalage D, Singh H, Kaman L, Yadav TD, Irrinki S, Saroch A, Gupta V, Saikia UN, Nada R, Gupta P, Srinivasan R, Dutta U. Dual-energy CT in differentiating benign gallbladder wall thickening from wall thickening type of gallbladder cancer. Eur Radiol 2025; 35:84-92. [PMID: 38980414 DOI: 10.1007/s00330-024-10904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/02/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE To evaluate the performance of dual-energy computed tomography (DECT) in differentiating non-acute benign from malignant gallbladder wall thickening (GBWT). METHODS This prospective study comprised consecutive adults with GBWT who underwent late arterial phase (LAP) and portal venous phase (PVP) DECT between January 2022 and May 2023. The final diagnosis was based on histopathology or 3-6 months follow-up imaging. DECT images in LAP and PVP were assessed independently by two radiologists. The demographic, qualitative, and quantitative parameters were compared between two groups Multivariate logistic regression was performed to determine the association between the aforementioned factors and malignant GBWT. RESULTS Seventy-five patients (mean age 56 ± 12.8 years, 46 females) were included. Forty-two patients had benign, and 33 had malignant GBWT. In the overall group, female gender (p = 0.018), lymphadenopathy (p = 0.011), and omental nodules (p = 0.044) were significantly associated with malignant GBWT. None of the DECT features differed significantly between benign and malignant GBWT in overall group. In the xanthogranulomatous cholecystitis (XGC, n = 9) vs. gallbladder cancer (GBC) (n = 33) subgroup, mean attenuation value at 140 keV LAP VMI was significantly associated with malignant GBWT [p = 0.023, area under curve 0.759 (95%CI 0.599-0.919)]. CONCLUSION DECT-generated quantitative parameters do not add value in differentiating non-acute benign from malignant GBWT. However, DECT may have a role in differentiating XGC from GBC in a selected subgroup of patients. Further, larger studies may be necessary to confirm these findings. CLINICAL RELEVANCE STATEMENT In patients with non-acute gallbladder wall thickening in whom there is suspicion of xanthogranulomatous cholecystitis (XGC), DECT findings may allow differentiation of XGC from wall thickening type of gallbladder cancer. KEY POINTS Differentiation of benign and malignant gallbladder wall thickening (GBWT) at CT is challenging. Quantitative dual energy CT (DECT) features do not provide additional value in differentiating benign and malignant GBWT. DECT may be helpful in a subgroup of patients to differentiate xanthogranulomatous cholecystitis from gallbladder cancer.
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Affiliation(s)
- Kakivaya Pavankumar Reddy
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarvinder Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Irrinki
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Saroch
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Min JH, Choi SY, Kim SH, Kim YK, Hwang JA, Cha DI, Lee JH, Baek SY, Lee JE. Should we suspect gallbladder cancer if which CT finding is observed in patients with localized gallbladder wall thickening? Eur J Radiol 2024; 176:111505. [PMID: 38796886 DOI: 10.1016/j.ejrad.2024.111505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To identify high-risk computed tomography (CT) features for predicting gallbladder (GB) cancer in patients presenting with localized GB wall thickening. METHODS This retrospective analysis included 120 patients (mean age: 63.9 ± 10.0 years; 51 men) exhibiting localized GB wall thickening on CT scans obtained between January 2008 and May 2017. Two radiologists independently evaluated CT imaging features for predicting GB cancer. The diagnostic performance of significant imaging features and their combinations was evaluated. High-risk CT features ranked by accuracy were delineated for predicting GB cancer. RESULTS This study included 55 patients with GB cancer and 65 with benign GB conditions. The top-four most accurate CT imaging features for predicting GB cancer were identified: heterogeneously enhancing single layer or strongly enhancing thick inner layer; GB wall thickness > 6.5 mm; hyperenhancement on arterial phase; and absence of intramural small cystic lesions (accuracies of 90.0 %, 88.3 %, 85.0 %, and 85.0 %, respectively). The combination of any three high-risk features exhibited the highest accuracy (94.2 %). The presence of any high-risk feature yielded a sensitivity of 100 %, whereas that of all high-risk features indicated a specificity of 100 %. CONCLUSION CT imaging features, whether alone or in combination, could effectively and accurately predict GB cancer among patients with localized GB wall thickening. This finding holds significance in guiding decisions regarding further diagnostic tests and treatment planning.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Sun-Young Baek
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Bucheon-Si, Gyeonggi-do 14584, Republic of Korea
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Han S, Lee YH, Kim YR, Soh EG. Usefulness of MRI Scoring System for Differential Diagnosis between Xanthogranulomatous Cholecystitis and Wall-Thickening Type Gallbladder Cancer. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:147-160. [PMID: 38362397 PMCID: PMC10864155 DOI: 10.3348/jksr.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 02/17/2024]
Abstract
Purpose To define an MRI scoring system for differentiating xanthogranulomatous cholecystitis (XGC) from wall-thickening type gallbladder cancer (GBC) and compare the diagnostic performance of the scoring system with the visual assessment of radiologists. Materials and Methods We retrospectively analyzed 23 and 35 patients who underwent abdominal MRI and were pathologically diagnosed with XGC and wall-thickening-type GBC after surgery, respectively. Three radiologists reviewed all MRI findings. We defined a scoring system using these MRI findings for differentiating XGC from wall-thickening type GBC and compared the area under the curve (AUC) of the scoring system with the visual assessment of radiologists. Results Nine MRI findings showed significant differences in differentiating the two diseases: diffuse gallbladder wall thickening (p < 0.001), mucosal uniformity (p = 0.002), intramural T2-high signal intensity (p < 0.001), mucosal retraction (p = 0.016), gallbladder stones (p < 0.001), T1-intermediate to high-signal intensity (p = 0.033), diffusion restriction (p = 0.005), enhancement pattern (p < 0.001), and phase of peak enhancement (p = 0.008). The MRI scoring system showed excellent diagnostic performance with an AUC of 0.972, which was significantly higher than the visual assessment of the reviewers. Conclusion The MRI scoring system showed better diagnostic performance than the visual assessment of radiologists to differentiate XGC from wall-thickening-type GBC.
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Patil NS, Kumar AH, Pamecha V, Gattu T, Falari S, Sinha PK, Mohapatra N. Cystic artery pseudoaneurysm-a rare complication of acute cholecystitis: review of literature. Surg Endosc 2021; 36:871-880. [PMID: 34811584 DOI: 10.1007/s00464-021-08796-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To acquaint with the presentation and management of the cystic artery aneurysm by enriching the reviewed literature with our own experience. BACKGROUND Cystic artery pseudoaneurysm is an uncommon entity with varied clinical presentation. Inflammation and trauma are associated with most of the cases. Limited experience with the condition challenges the management of individual cases. MATERIALS AND METHODS We retrieved all the reported cases of cystic artery pseudoaneurysm, published up to December 2019, from the PubMed database and excluded those arising as postoperative complications. A total of 59 cases were analyzed, and we also included our experience of managing a case of cystic artery pseudoaneurysm. RESULTS Abdominal pain (77.9%) was the most common presentation followed by upper GI bleed (64.4%), while 19 patients (32.2%) had presented with classic Quincke's Triad. Most of the cases were diagnosed following the rupture of the pseudoaneurysm (n = 49, 83.05%). Fifteen patients presented with shock. Hyperbilirubinemia (59.3%) and anemia (55.9%) were the commonest laboratory findings. Although CT angiogram remains the investigation of choice, a conventional angiogram is the gold standard and sufficed as the definitive management in 20 cases. Cholecystectomy formed the definitive management in the rest of the cases. We successfully managed a middle-aged female patient of cystic artery aneurysm with xanthogranulomatous cholecystitis by open cholecystectomy. CONCLUSION Cystic artery pseudoaneurysms are amenable to successful management with careful evaluation and timely cholecystectomy or angioembolization or a combination of both.
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Affiliation(s)
- Nilesh Sadashiv Patil
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Anubhav Harshit Kumar
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Viniyendra Pamecha
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
| | - Tharun Gattu
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Sanyam Falari
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Piyush Kumar Sinha
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Nihar Mohapatra
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
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Khan S, Abeer I, Husain M, Hassan MJ, Jetley S. Xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma - Analysis of 8 cases. J Cancer Res Ther 2021; 17:969-975. [PMID: 34528550 DOI: 10.4103/jcrt.jcrt_1180_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background/Aim Xanthogranulomatous cholecystitis (XGC) is a rare destructive inflammatory disease of the gallbladder. It is frequently misdiagnosed as gallbladder carcinoma (GBC) as it mimics latter with regard to clinical manifestations, imaging and intraoperative findings, often leading to extended surgical resection in these patients. The aim of this study was to evaluate the diagnostic dilemma of XGC cases clinico-radiologically diagnosed with GBC. Materials and Methods From January 2017 to June 2019, a total of eight cases histopathologically diagnosed as XGC, were misdiagnosed with GBC based on preoperative and intra-operative findings. The clinical characteristics, imaging, intra-operative findings, and surgical data of these patients were collected and analyzed. Results A total of 2154 cholecystectomy specimens were received in the histopathology section during the study period. Sixty-nine cases (3.2%) were histologically diagnosed as XGC, of which 8 cases (11.6%) were preoperatively diagnosed with GBC. These cases were predominantly seen in males in the age range of 24-62 years. The most common clinical presentation was chronic cholecystitis. Gallstones were present in all the 8 cases. Six cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging. Intraoperatively, adhesions to adjacent organs were observed in seven cases. All these eight cases misdiagnosed with GBC underwent aggressive surgical treatment following which histopathology ultimately revealed XGC. Conclusion Neither clinical manifestations nor laboratory tests/radiological methods can provide an effective means of differentiating between XGC and GBC. Preoperative diagnosis is difficult, and histopathology remains the gold standard to differentiate the two entities.
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Affiliation(s)
- Sabina Khan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Inara Abeer
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Musharraf Husain
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mohd Jaseem Hassan
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Gupta P, Marodia Y, Bansal A, Kalra N, Kumar-M P, Sharma V, Dutta U, Sandhu MS. Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol 2020; 26:6163-6181. [PMID: 33177791 PMCID: PMC7596646 DOI: 10.3748/wjg.v26.i40.6163] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Bansal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Suzuki H. Specific radiological findings, if present, can offer high accuracy for the differentiation of Xanthogranulomatous cholecystitis and gallbladder cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:662. [PMID: 32617282 PMCID: PMC7327357 DOI: 10.21037/atm.2020.03.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hideki Suzuki
- Department of Hepatobiliary and Pancreatic Surgery, Isesaki Municipal Hospital, Gunma, Japan
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8
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Reghunath A, Kushvaha S, Ghasi RG, Khanna G, Surana A. Chronic gallbladder wall thickening: Is it always malignancy? SA J Radiol 2020; 24:1844. [PMID: 32537253 PMCID: PMC7276480 DOI: 10.4102/sajr.v24i1.1844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/09/2020] [Indexed: 01/20/2023] Open
Abstract
Gallbladder wall thickening, associated with features like perforation, fistula formation and invasion of adjacent organs, is often assumed to be malignant. Xanthogranulomatous cholecystitis (XGC) causes gallbladder wall thickening with similar aggressive features and closely mimics gallbladder carcinoma clinically, radiologically and surgically. Differentiating between these two is crucial for management as misdiagnosis of gallbladder cancer can lead to unnecessary radical surgery. We report a case of chronic gallbladder wall thickening, initially suspected to be malignant, but subsequently diagnosed as XGC.
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Affiliation(s)
- Anjuna Reghunath
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Suchana Kushvaha
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohini G Ghasi
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetika Khanna
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Apurva Surana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Yu MH, Kim YJ, Park HS, Jung SI. Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol 2020; 26:2967-2986. [PMID: 32587442 PMCID: PMC7304100 DOI: 10.3748/wjg.v26.i22.2967] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea
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10
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Hanson ME, Donovan TA, Quesenberry K, Dewey A, Brown C, Chen S, Le Roux AB. Imaging features of disseminated xanthogranulomatous inflammation in eclectus parrots (Eclectus roratus). Vet Radiol Ultrasound 2020; 61:409-416. [PMID: 32436257 DOI: 10.1111/vru.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/05/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
Xanthogranulomatous disease is a rare condition, which can be caused by infection, inflammation, hemorrhage, immunologic disease, or inherited lysosomal disorders. It is characterized by non-intracellular lipid and cholesterol deposits among an inflammatory infiltrate of vacuolated macrophages and giant cells. The diagnosis of xanthogranulomatous disease is challenging, with nonspecific imaging findings often misinterpreted as aggressive neoplastic processes in humans. In this retrospective case series study, we describe the diagnostic imaging characteristics of a disseminated xanthogranulomatous condition identified in five eclectus parrots (Eclectus roratus). Decreased serosal detail and celomic distension were present in all three birds radiographed, with multifocal variably sized celomic mineralization (3/3 birds), and extracelomic mineralized masses (1/3 birds). Celomic effusion with foci of celomic mineralization and hepatomegaly were identified in all birds (3/3) imaged with ultrasound. Finally, a mineralized mural ventricular mass was present in one of three patients imaged with CT, multifocal celomic mineralization with moderate to severe celomic effusion in two of three patients, diffuse severe proventricular and intestinal dilation in all three patients, and atherosclerosis of the major arterial trunks in all three patients. Veterinary radiologists should be aware of this inflammatory condition in birds, especially in eclectus parrots, and should be able to recognize the imaging features of xanthogranulomatous inflammation.
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Affiliation(s)
| | - Taryn A Donovan
- Department of Anatomic Pathology, Animal Medical Center, New York, New York
| | | | - Amanda Dewey
- Department of Avian and Exotic Medicine, Animal Medical Center, New York, New York
| | - Cindy Brown
- Department of Avian and Exotic Medicine, Animal Medical Center, New York, New York
| | - Sue Chen
- Department of Avian and Exotic Medicine, Gulf Coast Veterinary Specialists, Houston, Texas
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Ito R, Kobayashi T, Ogasawara G, Kono Y, Mori K, Kawasaki S. A scoring system based on computed tomography for the correct diagnosis of xanthogranulomatous cholecystitis. Acta Radiol Open 2020; 9:2058460120918237. [PMID: 32313694 PMCID: PMC7160779 DOI: 10.1177/2058460120918237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/20/2020] [Indexed: 01/17/2023] Open
Abstract
Background Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic
cholecystitis. The differential diagnoses of XGC include gallbladder cancer
(GBC), adenomyomatosis, and actinomycosis of the gallbladder. Purpose To assess the usefulness of computed tomography (CT) findings in the
diagnosis of XGC and differentiation from GBC. Material and Methods We retrospectively assessed the pathological and radiological records of 13
patients with pathologically proven XGC and 33 patients with GBC. Results Significant differences were observed for the following five CT findings:
diffuse wall thickening (XGC = 85%, GBC = 15%,
P < 0.01); absence of polypoid lesions (XGC = 100%,
GBC = 48%, P < 0.01); intramural nodules or bands
(XGC = 54%, GBC = 9%, P < 0.01); pericholecystic
infiltration (XGC = 69%, GBC = 9%, P < 0.01); and
pericholecystic abscess (XGC = 23%, GBC = 0%, P = 0.018).
We defined the scoring system based on how many of the five CT findings were
observed. Our scoring system, which included these findings, revealed that
patients with three or more findings had sensitivity of 77% (95% confidence
interval [CI] = 57–87) and specificity of 94% (95% CI = 86–98). Conclusion Our scoring system can assist in the differentiation of XGC from GBC.
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Affiliation(s)
- Ryota Ito
- Department of Gastroenterological Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takashi Kobayashi
- Department of Gastroenterological Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gou Ogasawara
- Department of Diagnostic Radiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshiharu Kono
- Department of Gastroenterological Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuhiko Mori
- Department of Gastroenterological Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Seiji Kawasaki
- Department of Gastroenterological Surgery, Mitsui Memorial Hospital, Tokyo, Japan
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13
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Garg G, Kataria K, Bansal N, Singh I. Rare cause of gastric outlet obstruction: xanthogranulomatous cholecystitis. BMJ Case Rep 2018; 2018:bcr-2018-226580. [PMID: 30206069 DOI: 10.1136/bcr-2018-226580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, India
| | - Kamal Kataria
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nupur Bansal
- Department of Radiotherapy, King George's Medical University, Lucknow, India
| | - Iqbal Singh
- Department of Surgery, Urology Division, University College of Medical Sciences, New Delhi, India
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Min JH, Kang TW, Cha DI, Kim SH, Shin KS, Lee JE, Jang KT, Ahn SH. Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer. Eur Radiol 2018; 29:411-421. [DOI: 10.1007/s00330-018-5602-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/19/2018] [Accepted: 06/07/2018] [Indexed: 12/22/2022]
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Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD. Multimodality Imaging, including Dual-Energy CT, in the Evaluation of Gallbladder Disease. Radiographics 2018; 38:75-89. [DOI: 10.1148/rg.2018170076] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lisa Ratanaprasatporn
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jeremy R. Wortman
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Ian Richardson
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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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; 8:554-559. [PMID: 29203989 DOI: 10.1007/s13193-017-0677-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/10/2017] [Indexed: 12/17/2022] Open
Abstract
Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gallbladder carcinoma (GBC) both preoperatively and intra-operatively, since it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of this misdiagnosis which is not infrequent, the patient may need to undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy which is associated with greater morbidity and mortality. Patients who underwent gallbladder and gallbladder-related operations during period of 5 years between 2010 and 2014 were reviewed (n = 462). A comparison of clinical, biochemical, radiological and operative features were made between patients with carcinoma gallbladder (n = 101) and xanthogranulomatous cholecystitis (n = 22). Patient with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gallbladder wall (p < 0.01), with cholelithiasis, choledocholithiasis and sub-mucosal hypoattenuated nodules (p < 0.05) are likely to have XGC while those with anorexia, weight loss, focal thickening of the gallbladder wall on imaging (p < 0.01) and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of fat plane interface between the liver and gallbladder are not differentiating factors. Differentiating XGC from GBC in preoperative setting is necessary to avoid radical procedures being done for a benign process. Certain clinical, radiological and intra-operative features aid in differentiating these benign and malignant process. However, the definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.
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Affiliation(s)
- Rajaguru Kishore
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Siddharth Mehrotra
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Naimish Metha
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailendra Lalwani
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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Sureka B, Singh VP, Rajesh SR, Laroia S, Bansal K, Rastogi A, Bihari C, Bhadoria AS, Agrawal N, Arora A. 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; 82:327-332. [PMID: 28685006 PMCID: PMC5491692 DOI: 10.12659/pjr.901728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/18/2016] [Indexed: 01/18/2023] Open
Abstract
Background To study CT and MR findings in xanthogranulomatous cholecystitis (XGC). Material/Methods Retrospective analysis of 30 histopathologically confirmed cases of XGC. Seventeen patients underwent CECT and 13 underwent MRI. The following features were studied – wall thickness, intramural nodules, pericholecystic stranding, wall thickness, THAD, fat in gallbladder wall, cholelithiasis, infiltration, biliary dilatation, lymph nodes, complications. Results The majority of cases (22/30) showed discontinuous mucosal lining. Discontinuous mucosal lining was seen in all cases with wall thickness >10 mm, 75% of cases with wall thickness between 3–10 mm and none in normal wall thickness (p=0.03). Diffuse wall thickening was seen in 23 cases, focal thickening in 3 and polypoidal wall thickening in 2 cases. Polypoidal thickening was seen in gallbladder carcinoma. Intramural nodules were present in 87.5% of cases with discontinuous mucosal lining. Pericholecystic stranding was seen in 19, biliary dilatation in 12, liver infiltration in 13 and fat in 7 cases. Lymphadenopathy was seen in 1 case with gallbladder carcinoma. Four cases showed a signal drop in the intramural nodules on chemical shift MRI. Conclusions Discontinuous mucosal lining is evident in xanthogranulomatous cholecystitis. Diffuse wall thickening, intramural nodules, continuous or discontinuous mucosal lining and cholelithiasis may indicate XGC rather than gallbladder carcinoma. Based on correlation with pathophysiological findings, we conclude that discontinuous mucosal lining is not an unusual finding in cases of XGC. Advances in knowledge: Being aware of the radiological findings described in this article may be helpful in making preoperative radiological diagnosis of XGC. Mucosal lining may be continuous or discontinuous in XGC.
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Affiliation(s)
- Binit Sureka
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vaibhav Pratap Singh
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Rajesh Rajesh
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shalini Laroia
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kalpana Bansal
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ajeet Singh Bhadoria
- Department of Community Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nikhil Agrawal
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Asit Arora
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
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Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc 2017; 31:5289-5294. [DOI: 10.1007/s00464-017-5604-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/16/2017] [Indexed: 01/27/2023]
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Liu C, Huang P, Wang Y, Zhang X, You X. [Value of ultrasonography in diagnosis of xanthogranulomatous cholecystitis]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2017; 46:552-556. [PMID: 29488724 PMCID: PMC10400831 DOI: 10.3785/j.issn.1008-9292.2017.10.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/25/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the value of ultrasonography in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thickening type of gallbladder cancer (GBC). METHODS The clinical features and sonographic finding of 31 patients with XGC and 36 patients with wall-thickening type of GBC were retrospectively reviewed. The diagnosis of all cases was confirmed by pathological examination, and the ultrasonographic manifestations of the thickening of the gallbladder wall, intramural hypoechoic nodules, gallbladder mucosa line, gallbladder stones, biliary dilatation and gallbladder-liver boundary were compared between two groups. RESULTS There were significant differences in the intramural hypoechoic nodules, the continuous gallbladder wall mucosal line and dilatation of bile duct between XGC and GBC groups (all P<0.05), while no statistically significant differences in the other sonographic features(all P>0.05). In the six positive sonographic features of the XGC patients, the intramural hypoechoic nodules and the continuous mucosa line of the gallbladder wall had highest accuracy in the diagnosis of XGC(64.2% and 65.7%). CONCLUSIONS Intramural hypoechoic nodule and the continuous mucosal line are characteristic sonographic features of XGC, which can be used for the diagnosis of XGC.
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Affiliation(s)
- Chunmei Liu
- Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Pintong Huang
- Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yao Wang
- Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xu Zhang
- Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiangdong You
- Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses. AJR Am J Roentgenol 2017; 208:475-484. [PMID: 28095017 DOI: 10.2214/ajr.16.17075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Xanthogranulomatous (XG) processes are rare inflammatory conditions with the characteristic pathologic feature of lipid-laden macrophages or histiocyte cells. Imaging findings are nonspecific and can simulate aggressive neoplastic processes. XG processes can be caused by infection, inflammation, histolytic process, or an inherited lysosomal disorder. XG infectious processes are mainly seen in cholecystitis and pyelonephritis, but several other organs can also be involved. Histiocytic processes can be divided into Langerhans and non-Langerhans cell histiocytosis. The non-Langerhans cell histiocytosis entities include Erdheim-Chester disease, Rosai-Dorfman disease, juvenile xanthogranuloma, and hemophagocytic lymphohistiocytosis. The inherited lysosomal disorders resulting in XG processes include Nieman-Pick, Gaucher, and other lysosomal storage disorders. CONCLUSION Radiologists need to be able to recognize features of xanthogranulomatous processes to help facilitate patient management.
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Rajaguru K, Mehrotra S, Lalwani S, Mangla V, Mehta N, Nundy S. New scoring system for differentiating xanthogranulomatous cholecystitis from gall bladder carcinoma: a tertiary care centre experience. ANZ J Surg 2016; 88:E34-E39. [PMID: 27599003 DOI: 10.1111/ans.13733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by a focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gall bladder carcinoma (GBC) both preoperatively and intra-operatively, as it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of a misdiagnosis, which is not infrequent, the patient may undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy, which is associated with a greater morbidity and mortality. The main aim of the study is to formulate a simple preoperative scoring system for diagnosis of XGC which might benefit patients by avoiding radical procedures. METHODS A retrospective study was done from all the patients who underwent gall bladder and gall bladder-related operations (benign and malignant), during a 5-year time period from 2010 to 2014 in a tertiary care centre were reviewed (n = 462). RESULTS Initial analyses of all the clinical and imaging parameters were done. Patients with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gall bladder wall, cholelithiasis, choledocholithiasis and submucosal hypoattenuated nodules are likely to have XGC while those with anorexia, weight loss, focal thickening of the gall bladder wall on imaging and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of a fat plane interface between the liver and gall bladder are not differentiating factors. A scoring system was made by taking statistically significant features (n = 13) of clinical and imaging parameters in initial assessment to identify the features of XGC. The same scoring system was subsequently applied to the patients who underwent cholecystectomy to study the effectiveness and the results were reviewed. CONCLUSION High value scores (≥11/13) helps in diagnosing XGC in preoperative setting. Hence, intra-operative frozen section analysis can be avoided in such cases to differentiate XGC and GBC. However in difficult cases with high suspicion of malignancy based on clinical experience, definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.
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Affiliation(s)
- Kishore Rajaguru
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Siddharth Mehrotra
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailendra Lalwani
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma. ACTA ACUST UNITED AC 2016; 40:2281-92. [PMID: 25952571 DOI: 10.1007/s00261-015-0432-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate the diagnostic performance of HRUS, CT, and MRI for differentiating xanthogranulomatous cholecystitis (XGC) from gallbladder (GB) cancer. MATERIALS AND METHODS Patients with surgically proven XGC (n = 40) and GB cancer (n = 44), who had undergone at least one HRUS (n = 43), CT (n = 82), or MRI (n = 34) examination between 2000 and 2012, were included. Two radiologists retrospectively graded the likelihood of XGC or GB cancer using a 5-point confidence scale; they also assessed the imaging features. Statistical analyses were performed using ROC, ANOVA, and Fisher's exact test. RESULTS Diagnostic performance of MRI was better than HRUS for differentiating XGC from GB cancer (AUCs = 0.867 and 0.911 vs. AUCs = 0.818 and 0.86). However, HRUS showed a better performance than CT (AUCs = 0.818 and 0.86 vs. AUCs = 0.806 and 0.84) with moderate to excellent agreement (κ = 0.48-0.83). Statistically common findings for XGC included non-focal thickening, smooth GB wall, presence of intramural nodules, type I enhancement of wall, transient hepatic attenuation difference, and continuity of mucosa (p < 0.05). Co-existence of gallstones (OR = 16.5), non-focal thickening (OR = 14.7), and collapsed lumen (OR = 13.0) on HRUS, and type I enhancement on CT (OR = 3.52) were independently associated with XGC (p < 0.05). CONCLUSION Although MRI showed a better performance than both HRUS and CT, HRUS showed a better performance than CT. The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.
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Kitazume Y, Taura SI, Nakaminato S, Noguchi O, Masaki Y, Kasahara I, Kishino M, Tateishi U. Diffusion-weighted magnetic resonance imaging to differentiate malignant from benign gallbladder disorders. Eur J Radiol 2016; 85:864-73. [PMID: 26971436 DOI: 10.1016/j.ejrad.2016.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To retrospectively evaluate the utility of apparent diffusion coefficient (ADC) and lesion to spinal cord ratio (LSR) in diffusion-weighted magnetic resonance (MR) imaging (DWI) as compared with morphological assessment alone, for differentiating malignant from benign gallbladder disorders. METHODS This study was approved by the ethics committee, and written informed consent was waived. Ninety-one patients (13 malignancy and 78 benignancy) were reviewed. ADC was calculated using two DW images with different motion-probing gradient strengths (b=0, 1000s/mm(2)). LSR was measured by dividing the signal intensity of a thickened gallbladder wall by the maximum signal intensity of the lumbar enlargement of the spinal cord. In addition, the morphology of the gallbladders was assessed with conventional MR imaging. RESULTS In receiver operating characteristic curve analysis, the areas under the curves for ADC and LSR were 0.861 and 0.906, respectively. Three morphological findings were considered: a massive formation, a disrupted mucosal line, and the absence of a two-layered pattern. When a combination of two or more of these morphological findings was positive for malignancy, the sensitivity, specificity, and accuracy were 76.9%, 84.0%, and 83.0%, respectively. When a combination of three or more of the above morphological findings together with ADC of less than 1.2 × 10(-3)mm(2)/s or LSR of more than 0.48 were positive for malignancy, these values were 73.0%, 96.2%, and 92.9%, respectively. There were significant differences in specificity and accuracy. CONCLUSION Use of ADC and LSR in DWI can improve diagnostic performance for differentiating malignant from benign gallbladder disorders.
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Affiliation(s)
- Yoshio Kitazume
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shin-Ichi Taura
- Department of Radiology, Ome Municipal General Hospital, 4-16-5, Higashi-Ome, Ome City, Tokyo 198-0042, Japan
| | - Shuichiro Nakaminato
- Department of Radiology, Ome Municipal General Hospital, 4-16-5, Higashi-Ome, Ome City, Tokyo 198-0042, Japan
| | - Osamu Noguchi
- Department of Gastroenterology, Ome Municipal General Hospital, 4-16-5, Higashi-Ome, Ome City, Tokyo 198-0042, Japan
| | - Yukiyoshi Masaki
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi-Ome, Ome City, Tokyo 198-0042, Japan
| | - Ichiro Kasahara
- Department of Pathology, Ome Municipal General Hospital, 4-16-5, Higashi-Ome, Ome City, Tokyo 198-0042, Japan
| | - Mitsuhiro Kishino
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8519, Japan.
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Xanthogranulomatous Cholecystitis Mimicking Biliary Tract Cancer. ACG Case Rep J 2015; 3:57-9. [PMID: 26504881 PMCID: PMC4612761 DOI: 10.14309/crj.2015.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022] Open
Abstract
We present a 42-year-old man with a 1-month history of painless jaundice, dark urine, clay-colored stools, and a 13.5-kg weight loss. Laboratory tests revealed elevated liver enzymes and CA19-9. Imaging showed dilation of both the intra- and extrahepatic bile ducts, narrowing of the bile duct at the junction of the common bile duct and common hepatic duct, and a hypoechoic mass involving the neck of the gallbladder and the muscularis propria of the duodenum. Examination of the resected gallbladder and perihilar nodes ruled out malignancy and revealed a diffuse inflammatory infiltrate of giant histiocytes with clear, lipid-containing cytoplasm (xanthoma cells), consistent with xanthogranulomatous cholecystitis.
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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; 19:1036-42. [PMID: 25895976 DOI: 10.1007/s11605-015-2818-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/01/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis is an unusual inflammatory process of the gallbladder which is difficult to diagnose and manage and may be confused with gallbladder cancer. Many surgeons and pathologists are not familiar with this condition. We aim to highlight this condition and to review the role of laparoscopy in its management. PATIENTS AND METHODS We reviewed the records of 4406 patients who underwent cholecystectomy in 8 years at two teaching hospitals in North Jordan. Forty-two cases of Xanthogranulomatous cholecystitis were identified. The details of these patients were analyzed. The findings were compared with results of a previous study in all cholecystectomy patients conducted in the same centers. RESULTS The incidence of Xanthogranulomatous cholecystitis was 0.95 %. Twenty-five patients (59.5 %) presented as acute emergencies. Nine patients (21.4 %) had jaundice. Ultrasound showed marked gallbladder wall thickening in 36 patients (85.7 %). Compared with all cholecystectomy patients, xanthogranulomatous cholecystitis patients showed higher conversion rate from laparoscopic to open cholecystectomy (31.4 vs. 3.2 %, p < 0.001) and higher morbidity (33.3 vs. 6.4 % p < 0.001). CONCLUSIONS Xanthogranulomatous cholecystitis is rare. Acute presentation, associated jaundice, and gallbladder wall thickening should raise the suspicion of the condition. Laparoscopic cholecystectomy is associated with high conversion rate.
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Iwama A, Yamazaki S, Mitsuka Y, Yoshida N, Moriguchi M, Higaki T, Takayama T. A Longitudinal Computed Tomography Imaging in the Diagnosis of Gallbladder Cancer. Gastroenterol Res Pract 2015; 2015:254156. [PMID: 26064088 PMCID: PMC4433700 DOI: 10.1155/2015/254156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/04/2015] [Accepted: 04/07/2015] [Indexed: 01/15/2023] Open
Abstract
Background/Aim. To assess whether the diagnostic power of longitudinal multiplanar reformat (MPR) images is superior to that of conventional horizontal images for gallbladder cancer (GBC). Methods. Between 2006 and 2010, a total of 54 consecutive patients with preoperatively diagnosed gallbladder neoplasms located in gallbladder bed were analyzed. These patients underwent cholecystectomy with resection of the adjacent liver parenchyma. The patients were divided into the GBC group (n = 30) and the benign group (n = 24). MPR images obtained by preoperative multidetector row CT (MDCT) were assessed. Results. Mucosal line was more significantly disrupted in GBC group than that in benign group (93% [28/30 patients] versus 13% [3/24], p < 0.001). Maximum (9.3 [4.2-24.8] versus 7.0 mm [2.4-22.6], p = 0.29) and minimum (1.2 [1.0-2.4] versus 1.3 mm [1.0-2.6], p = 0.23) wall thicknesses on a single MPR plane did not differ significantly; however, the wall thickness ratio (max/min) differed significantly (6.8 [1.92-14.0] versus 5.83 [2.3-8.69], p = 0.04). Partial liver enhancement adjacent to tumor on longitudinal images was more common in GBC (40.0% [12/30 patients] versus 12.5% [3/24], p = 0.03). Mucosal line disruption was the most reliable independent predictor of diagnosis (odds ratio, 8.5; 95% CI, 5.99-28.1, p < 0.001). Conclusion. Longitudinal MPR images are more useful than horizontal images for the diagnosis of GBC.
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Affiliation(s)
- Atsuko Iwama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Shintaro Yamazaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Yusuke Mitsuka
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Nao Yoshida
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kami-machi, Itabashi-ku, Tokyo 173-8610, Japan
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Bennett GL. Cholelithiasis, Cholecystitis, Choledocholithiasis, and Hyperplastic Cholecystoses. TEXTBOOK OF GASTROINTESTINAL RADIOLOGY, 2-VOLUME SET 2015:1348-1391. [DOI: 10.1016/b978-1-4557-5117-4.00077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Xu JM, Guo LH, Xu HX, Zheng SG, Liu LN, Sun LP, Lu MD, Wang WP, Hu B, Yan K, Hong D, Tang SS, Qian LX, Luo BM. Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2794-2804. [PMID: 25438861 DOI: 10.1016/j.ultrasmedbio.2014.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 06/04/2023]
Abstract
he purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of gallbladder wall (GBW) thickening and determine the predictors of malignant GBW thickening. One hundred fifty-nine patients with GBW thickening, including 76 men and 83 women, from eight institutions were enrolled. CEUS was performed after injection of a sulfur hexafluoride microbubble-based ultrasound contrast agent. Multiple logistic regression analysis was used to reveal independent predictor sassociated with malignant GBW thickening. The final diagnoses were 48 gallbladder carcinomas and 111 benign gallbladder diseases.Maximal thicknesses of the GBW in malignant and benign GB Wthickening were 17.3 ± 5.2 (6 – 30) mm and 8.6 ± 5.1 (4 – 26) mm respectively (p , 0.001). CEUS revealed significant differences in intralesional vessels, enhancement homogeneity, time to hypo-enhancement, inner layer discontinuity, outer layer discontinuity and adjacent liver involvement (all p-values , 0.05) between malignant and benign GBW thickening. Patient age . 46.5 y, focal GBW thickening, inner layer discontinuity and outer layer discontinuity were found to be associated with malignancy by multiple logistic regression analysis (all p-values , 0.05). Receiver operating characteristic curve analysis revealed Az values for patient age, focal GBW thickening, inner wall discontinuity and outer wall discontinuity of 0.709 (95%confidence interval [CI]: 0.627–0.790), 0.714 (95% CI: 0.630–0.798), 0.860 (95%CI: 0.791 – 0.928) and 0.858 (95% CI: 0.783 – 0.933), respectively. CEUS is useful in the differential diagnosis between malignant and benign GBW thickening. Focal GBW thickening, inner wall discontinuity and outer wall discontinuity observed on CEUS are diagnostic clues for malignant GBW thickening.
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Affiliation(s)
- Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, Shanghai, China
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Xanthogranulomatous cholecystitis masquerading as gallbladder cancer: can it be diagnosed preoperatively? Gastroenterol Res Pract 2014; 2014:253645. [PMID: 25404941 PMCID: PMC4227324 DOI: 10.1155/2014/253645] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 12/21/2022] Open
Abstract
Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.
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Revzin MV, Scoutt L, Smitaman E, Israel GM. The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. ACTA ACUST UNITED AC 2014; 40:385-99. [DOI: 10.1007/s00261-014-0203-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Ewelukwa O, Ali O, Akram S. Xanthogranulomatous cholecystitis mimicking gallbladder cancer. BMJ Case Rep 2014; 2014:bcr-2013-200530. [PMID: 24811556 DOI: 10.1136/bcr-2013-200530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.
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Affiliation(s)
- Ofor Ewelukwa
- Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
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32
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Corona-Villalobos CP, Pawlik TM, Kamel IR. Imaging of the Patient with a Biliary Tract or Primary Liver Tumor. Surg Oncol Clin N Am 2014; 23:189-206. [DOI: 10.1016/j.soc.2013.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kang TW, Kim SH, Park HJ, Lim S, Jang KM, Choi D, Lee SJ. Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: added value of diffusion-weighted MRI. Clin Radiol 2013; 68:992-1001. [PMID: 23622795 DOI: 10.1016/j.crad.2013.03.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the benefit of diffusion-weighted imaging (DWI) in differentiating xanthogranulomatous cholecystitis from the wall-thickening type of gallbladder cancer. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. Fourteen patients with xanthogranulomatous cholecystitis and 19 patients with the wall-thickening type of gallbladder cancer were included. Qualitative (visual diffusion restriction compared to liver parenchyma) and quantitative [apparent diffusion coefficient (ADC)] analyses were performed. Conventional MRI findings including dynamic enhancement pattern between the two groups were also analysed. Two observers independently reviewed conventional magnetic resonance imaging (MRI) images and subsequently reviewed combined conventional MRI and DWI images. Pairwise comparison of the receiver operating characteristic (ROC) curves was used to compare diagnostic performances. RESULTS In conventional MRI findings, xanthogranulomatous cholecystitis showed significant continuity of enhancing mucosal line [79% (11/14) versus 26% (5/19), p = 0.003] and intramural T2-high signal intensity [64% (9/14) versus 21% (4/19), p = 0.012] compared to the wall-thickening type of gallbladder cancer. The enhancement pattern of gallbladder cancer compared to liver parenchyma showed earlier onset than that of xanthogranulomatous cholecystitis (p = 0.001). Diffusion restriction was more frequently seen in the wall-thickening type of gallbladder cancer (68%, 13/19) than in xanthogranulomatous cholecystitis (7%, 1/14; p < 0.001). The mean ADC value of xanthogranulomatous cholecystitis was higher than that of the wall-thickening type of gallbladder cancer with statistical significance (1.637 × 10(-3) mm(2)/s versus 1.076 × 10(-3) mm(2)/s, p = 0.005). Diagnostic performance [area under ROC curve (Az)] of both observers improved significantly after additional review of DWI; Az improved from 0.737 to 0.930 (p = 0.027) for observer 1 and from 0.675 to 0.938 (p = 0.008) for observer 2. CONCLUSION Addition of DWI to conventional MRI improves discrimination between xanthogranulomatous cholecystitis and the wall-thickening type of gallbladder cancer.
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Affiliation(s)
- T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
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Agarwal AK, Kalayarasan R, Javed A, Sakhuja P. Mass-forming xanthogranulomatous cholecystitis masquerading as gallbladder cancer. J Gastrointest Surg 2013; 17:1257-1264. [PMID: 23615807 DOI: 10.1007/s11605-013-2209-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mass-forming xanthogranulomatous cholecystitis (XGC), an uncommon inflammatory pathology of gallbladder (GB), masquerades as gallbladder cancer (GBC) and diagnosis is often a histological surprise. METHODS A retrospective analysis of prospectively collected database of patients with GB mass operated between August 2009 and September 2012 was conducted to determine clinical, radiological, and intraoperative findings that might aid in the preoperative diagnosis of mass-forming XGC and ascertain their optimal management strategy. RESULTS Of the 566 patients with GB mass and suspected GBC, 239 were found to be inoperable on preoperative workup and 129 patients had unresectable disease on staging laparoscopy/laparotomy. Of the 198 with resectable disease, 31 were reported as XGC on final histopathology (Group A), while 167 were GBC (Group B). Of these 31 patients, six with an intraoperative suspicion of benign pathology underwent cholecystectomy with segments IVb and V resection, and frozen section histopathology. Twenty-five underwent radical cholecystectomy, with (n = 10) or without (n = 15) adjacent organ resection. In comparison, anorexia and weight loss were significantly more in Group B (p = 0.001 and <0.001). Intraoperatively, empyema and associated gallstones were more common in Group A (p = 0.011 and <0.001). On computed tomography (CT) of the abdomen, continuous mucosal line enhancement and intramural hypodense bands were significantly more in Group A (p < 0.001 and 0.025). While CT abdomen revealed one or more features suggestive of XGC in 64.5 % (20/31) of patients in Group A, 11(35.5 %) did not have any findings suggestive of XGC on imaging. CONCLUSION Mass-forming XGC mimics GBC, making preoperative and intraoperative distinction difficult. While imaging findings can help in suspecting XGC, definitive diagnosis require histopathological examination. Presence of typical radiological findings, however, can help in avoiding extended radical resection in selected cases.
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Zhao F, Lu PX, Yan SX, Wang GF, Yuan J, Zhang SZ, Wang YXJ. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases. Eur J Radiol 2013; 82:1391-7. [PMID: 23726123 DOI: 10.1016/j.ejrad.2013.04.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To study the CT and MR features of xanthogranulomatous cholecystitis (XGC). MATERIALS AND METHODS 49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed. RESULTS On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥ 4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n=3), stomach (n=2), and abdominal wall (n=1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images. CONCLUSION Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall.
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Affiliation(s)
- Feng Zhao
- Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
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36
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Intense FDG Activity in a Case of Xanthogranulomatous Cholecystitis Without Elevated Fluorothymidine Activity. Clin Nucl Med 2013; 38:e205-6. [DOI: 10.1097/rlu.0b013e3182641cdd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martins PN, Sheiner P, Facciuto M. Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis. Hepatobiliary Pancreat Dis Int 2012; 11:549-52. [PMID: 23060404 DOI: 10.1016/s1499-3872(12)60223-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.
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Affiliation(s)
- Paulo N Martins
- Department of Surgery, Transplant Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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38
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Cui Y, Zhang H, Zhao E, Cui N, Li Z. Differential diagnosis and treatment options for xanthogranulomatous cholecystitis. Med Princ Pract 2012; 22:18-23. [PMID: 22814128 PMCID: PMC5586703 DOI: 10.1159/000339659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/22/2012] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To describe the differential diagnosis and treatment options for xanthogranulomatous cholecystitis (XGC), the presentations and management of 68 patients were described. SUBJECTS AND METHODS Demographical and clinical data from 68 cases of XGC treated between January 2004 and January 2010 were analyzed. Clinical characteristics, radiological and surgical findings, histopathological features and postoperative recoveries were recorded. Clinical features of laparoscopic cholecystectomy versus open surgery and XGC versus gallbladder (GB) cancer were compared. RESULTS The CA19-9 levels of XGC and coexisting GB cancer were significantly different (p = 0.0034). In radiological findings, focal thickening of the GB wall was more frequent in coexisting GB cancer, early enhancement of the GB was observed more often in coexisting GB cancer, and lymph node enlargement was seen more often in coexisting GB cancer (p < 0.05). There were also significant differences between laparoscopic and open surgery for CA19-9, intramural hypoattenuated nodule, pericholecystic invasion, lymph node enlargement and maximum thickness, focal thickening, heterogeneous enhancement and early enhancement of the GB wall (p < 0.05). These findings were confirmed by multivariate analysis. CONCLUSIONS Ultrasound, computed tomography scan and intraoperative frozen section were the helpful modalities for XGC diagnosis. CA19-9 (>37 kU/l), pericholecystic invasion, lymph node enlargement (>10 mm), and focal thickening and early enhancement of the GB wall were the criteria for open surgery. In some selected cases, laparoscopic cholecystectomy was preferable.
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Affiliation(s)
| | | | | | | | - Zhonglian Li
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
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Darji P, Thakkar G, Prajapati S. Heterogenous wall thickening of gall blabber: xanthogranulomatous cholecystitis or carcinoma, with type 3 choledochal cyst. BMJ Case Rep 2012; 2012:bcr.03.2012.5963. [PMID: 22729338 DOI: 10.1136/bcr.03.2012.5963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterised by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. The authors present a case of xanthogranulomatous cholecystitis with type 3 choledochal cyst in a 20-year-old man who was referred to our hospital with a 1-week history of abdominal pain and fever. He underwent endoscopic sphincterotomy and then open cholecystectomy. A histological diagnosis of xanthogranulomatous cholecystitis was made.
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Affiliation(s)
- Parth Darji
- Radiology Department, NHL MMC, Ahmedabad, India.
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40
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Lim KS, Peters CC, Kow A, Tan CH. The varying faces of gall bladder carcinoma: pictorial essay. Acta Radiol 2012; 53:494-500. [PMID: 22547386 DOI: 10.1258/ar.2012.110684] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this review is to highlight the pertinent imaging features and potential pitfalls in the diagnosis and staging of gall bladder carcinoma. This condition is notoriously non-specific on imaging on many occasions, particularly in its early stages; gall bladder carcinoma shows numerous features that overlap with a large number of benign conditions, leading to delayed diagnosis and incurable disease. Radiologists should be familiar with its typical and atypical imaging features.
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Affiliation(s)
- Kian Soon Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Cynthia C Peters
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Alfred Kow
- Department of General Surgery, National University Hospital, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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41
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Shetty GS, Abbey P, Prabhu SM, Narula MK, Anand R. Xanthogranulomatous cholecystitis: sonographic and CT features and differentiation from gallbladder carcinoma: a pictorial essay. Jpn J Radiol 2012; 30:480-5. [PMID: 22488612 DOI: 10.1007/s11604-012-0080-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 03/21/2012] [Indexed: 12/19/2022]
Abstract
The imaging features of xanthogranulomatous cholecystitis closely resemble those of gallbladder carcinoma, especially those of the wall-thickening variety. There is an overlap between these two conditions with respect to the clinical features and certain imaging findings. However, certain finer details like the presence of intramural hypoattenuating nodules and the type of mucosal enhancement may help to differentiate these two conditions. In this article, we have highlighted some of these imaging features. The importance of making an accurate diagnosis lies in the significant difference between the prognosis and the surgical management of the two disease entities.
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Affiliation(s)
- Gurucharan S Shetty
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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42
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Psarras K, Baltatzis ME, Symeonidis N, Pavlidis ET, Miha A, Pavlidis TE, Sakantamis AK. A severe case of xanthogranulomatous cholecystitis along with a review of CT indications for nonoperative management including percutaneous drainage. Surg Laparosc Endosc Percutan Tech 2012; 22:e42-e44. [PMID: 22318078 DOI: 10.1097/sle.0b013e318241bf29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis is a rare but severe presentation of cholecystitis characterized by extensive inflammation of the gallbladder wall with characteristic histopathological features. Frequently, the inflammatory mass resembles gallbladder cancer macroscopically, which further complicates therapeutic decisions. CASE PRESENTATION We report a case of xathogranulomatous cholecystitis with characteristic computed tomography findings, which was managed by percutaneous drainage of the gallbladder, giving the opportunity for a delayed elective cholocystectomy with an excellent postoperative outcome. DISCUSSION Recent studies give emphasis on certain criteria for the differential diagnosis of xanthogranulomatous cholecystitis against carcinoma. Characteristic computed tomography features are usually sufficient to establish the diagnosis with safety and decide a nonoperative management of the disease in the acute phase. Percutaneous gallbladder drainage is regarded as a safe and an efficient method for the initial treatment of severe cases.
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Affiliation(s)
- Kyriakos Psarras
- Propedeutical Department of Surgery, Medical School, Aristotle University, Hippokrateion Hospital, Thessaloniki, Greece.
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Cecava ND, Andrews R. Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology. J Radiol Case Rep 2011; 5:19-24. [PMID: 22470787 DOI: 10.3941/jrcr.v5i4.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A case of xanthogranulomatous cholecystitis is presented with a brief review of its sonographic and magnetic resonance features. These imaging features are also compared to those seen in gallbladder adenomyomatosis and gallbladder carcinoma. While there are many overlapping imaging findings in these entities, it is important to recognize distinguishing characteristics so a correct surgical approach is chosen. Laparoscopic cholecystectomy attempted with existing xanthogranulomatous cholecystitis has an increased surgical complication rate compared to open cholecystectomy and often necessitates intraoperative conversion to open cholecystectomy.
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Affiliation(s)
- Nathan D Cecava
- Department of Radiology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA.
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44
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Ueda J, Yoshida H, Arima Y, Mamada Y, Taniai N, Mineta S, Yoshioka M, Kawano Y, Naito Z, Uchida E. A Case of Xanthogranulomatous Cholecystitis Preoperatively Diagnosed with Contrast-enhanced Ultrasonography. J NIPPON MED SCH 2011; 78:194-8. [PMID: 21720095 DOI: 10.1272/jnms.78.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Junji Ueda
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Yasuo Arima
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Yasuhiro Mamada
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Nobuhiko Taniai
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Sho Mineta
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Masato Yoshioka
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Youichi Kawano
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
| | - Zenya Naito
- Department of Pathology, Nippon Medical School
| | - Eiji Uchida
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School
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Chang BJ, Kim SH, Park HY, Lim SW, Kim J, Lee KH, Lee KT, Rhee JC, Lim JH, Lee JK. Distinguishing xanthogranulomatous cholecystitis from the wall-thickening type of early-stage gallbladder cancer. Gut Liver 2010; 4:518-523. [PMID: 21253302 PMCID: PMC3021609 DOI: 10.5009/gnl.2010.4.4.518] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/24/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIMS Xanthogranulomatous cholecystitis (XGC) mimics early-stage gallbladder (GB) cancer with wall thickening on computed tomography (CT), both clinically and radiologically. Preoperative differentiation of XGC from early-stage GB cancer is important for selecting the most appropriate surgical management. Therefore, we evaluated the clinical features and multidetector CT (MDCT) findings of XGC to determine whether it can be distinguished from early-stage GB cancer. METHODS We retrospectively evaluated 25 patients with XGC and 56 patients with the wall-thickening type of T1- and T2-stage GB cancer, where all of the diagnoses were pathologically confirmed by surgical treatment. All of the patients underwent preoperative MDCT. The clinical symptoms, laboratory findings, and CT findings were compared. RESULTS Abdominal pain, fever, and jaundice were noted more frequently in the patients with XGC. Serum aspartate aminotransferase and alanine aminotransferase levels were more elevated in patients with XGC, whereas carbohydrate antigen (CA 19-9) was higher in the patients with GB cancer. When the T-category cancer staging of XGC and early-stage GB cancer were compared, diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration were consistent significant findings associated with XGC, regardless of the cancer staging. CONCLUSIONS MDCT findings such as diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration together with the clinical symptoms, can provide clues for physicians to differentiate XGC from early-stage GB cancer with wall thickening on CT.
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Affiliation(s)
- Byung Jin Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yong Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Lim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Taek Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ahmed I, Tanveer UH, Sajjad Z, Munazza B, Azeem UD, Basit S. Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecystitis. Br J Radiol 2010; 83:e165-7. [PMID: 20675459 DOI: 10.1259/bjr/34623636] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and around the gastrohepatic ligament. A thick haemorrhagic pus, from which Escherichia coli was cultured, was drained from the gastrohepatic collection. An elective coeliac angiogram demonstrated a solitary pseudo-aneurysm of the medial branch of the cystic artery. Selective catheterisation of this artery with a micro-catheter enabled complete exclusion of the pseudo-aneurysm by a single micro-coil. Histological examination of the gallbladder, which was ultimately removed at open cholecystectomy, demonstrated xanthogranulomatous cholecystitis.
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Affiliation(s)
- I Ahmed
- Department of Radiology, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
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Sharma D, Babu R, Sood G, Kapoor G, Solanki RS, Thomas S. Xanthogranulomatous cholecystitis masquerading as malignancy with liver metastasis. ANZ J Surg 2010; 79:946-7. [PMID: 20003001 DOI: 10.1111/j.1445-2197.2009.05150.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Deborshi Sharma
- Department of Surgery, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
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Lee TY, Ko SF, Huang CC, Ng SH, Liang JL, Huang HY, Chen MC, Sheen-Chen SM. Intraluminal versus infiltrating gallbladder carcinoma: Clinical presentation, ultrasound and computed tomography. World J Gastroenterol 2009; 15:5662-8. [PMID: 19960562 PMCID: PMC2789218 DOI: 10.3748/wjg.15.5662] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare clinical presentation and ultrasound (US) and computed tomography (CT) sensitivity between intraluminal and infiltrating gallbladder carcinoma (GBCA).
METHODS: This retrospective study evaluated 65 cases of GBCA that were categorized morphologically into the intraluminal-GBCA (n = 37) and infiltrating-GBCA (n = 28) groups. The clinical and laboratory findings, presence of gallstones, gallbladder size, T-staging, nodal status, sensitivity of preoperative US and CT studies, and outcome were compared between the two groups.
RESULTS: There were no significant differences between the two groups with respect to female predominance, presence of abdominal pain, serum aminotransferases level, T2-T4 staging, and regional metastatic nodes. Compared with the patients with intraluminal-GBCA, those with infiltrating-GBCA were significantly older (65.49 ± 1.51 years vs 73.07 ± 1.90 years), had a higher frequency of jaundice (3/37 patients vs 13/28 patients) and fever (3/37 patients vs 10/28 patients), higher alkaline phosphatase (119.36 ± 87.80 IU/L vs 220.68 ± 164.84 IU/L) and total bilirubin (1.74 ± 2.87 mg/L vs 3.50 ± 3.51 mg/L) levels, higher frequency of gallstones (12/37 patients vs 22/28 patients), smaller gallbladder size (length, 7.47 ± 1.70 cm vs 6.47 ± 1.83 cm; width, 4.21 ± 1.43 cm vs 2.67 ± 0.93 cm), and greater proportion of patients with < 12 mo survival (16/37 patients vs 18/28 patients). The sensitivity for diagnosing intraluminal-GBCA with and without gallstones was 63.6% and 91.3% by US, and 80% and 100% by CT, respectively. The sensitivity for diagnosing infiltrating-GBCA with and without gallstones was 12.5% and 25% by US, and 71.4% and 75% by CT, respectively.
CONCLUSION: In elderly women exhibiting small gallbladder and gallstones on US, especially those with jaundice, fever, high alkaline phosphatase and bilirubin levels, CT may reveal concurrent infiltrating-GBCA.
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Abstract
Gallbladder and biliary system pathologic component is a spectrum of benign and malignant conditions. Standard magnetic resonance imaging techniques when used together with magnetic resonance cholangiopancreatography (MRCP) can evaluate gallbladder and biliary system pathologic conditions. Inflammatory diseases are characterized by thickening and intense mucosal contrast enhancement of the affected bile ducts and or gallbladder wall. Postinflammatory changes can be appreciated on MRCP with short or long segment strictures of the bile ducts. Serial contrast-enhanced images show reactive inflammatory changes in the liver parenchyma. Neoplastic diseases of the gallbladder and the biliary tree are evaluated on T2-weighted fat-suppressed echo train and serial contrast-enhanced images and their obstructive effect can be displayed on MRCP images. In this paper, we will review the spectrum of MRI findings of gallbladder and biliary system pathologic conditions.
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Makino I, Yamaguchi T, Sato N, Yasui T, Kita I. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET. World J Gastroenterol 2009; 15:3691-3. [PMID: 19653352 PMCID: PMC2721248 DOI: 10.3748/wjg.15.3691] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in differentiating between benign and malignant lesions in the gallbladder. However, there is a limitation in the ability of FDG-PET to differentiate between inflammatory and malignant lesions. We herein present a case of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma by ultrasonography and computed tomography. FDG-PET also showed increased activity. In this case, FDG-PET findings resulted in a false-positive for the diagnosis of gallbladder carcinoma.
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