Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12653
Peer-review started: January 13, 2015
First decision: January 22, 2015
Revised: August 26, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: November 28, 2015
AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically.
METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed.
RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon’s macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon’s macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05).
CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.
Core tip: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that could mimic gallbladder carcinoma (GBC) in various ways. The aim of this study was to review and evaluate the diagnostic dilemma of XGC clinically. We concluded that neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC. For XGC with suspected GBC, intra-operative frozen section analysis should be performed, and the benign diagnosis indicates that a simple cholecystectomy is appropriate. However, the final diagnosis still depends on the pathology.