Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8671
Peer-review started: September 13, 2017
First decision: October 10, 2017
Revised: October 13, 2017
Accepted: November 21, 2017
Article in press: November 21, 2017
Published online: December 28, 2017
Three patients presented with jaundice and variable other symptoms, including abdominal pain and weight loss.
Clinical findings were suggestive of neoplastic processes affecting directly or indirectly the biliary tree.
Serum bilirubin was elevated in all three cases, while serum CA-19.9 levels were normal.
Laboratory tests and imaging studies were performed to clarify the diagnosis.
Abdominal imaging studies, including CT and magnetic resonance cholangiopancreatography, demonstrated widely infiltrative hilar mass lesions with associated vascular affectation and retrograde biliary dilatation.
Since all three patients had aggressive yet apparently resectable lesions, surgery was undertaken without previous biopsy.
All three interventions were performed according to oncological principles and included, at a minimum, radical cholecystectomy, common bile duct excision, hilar lymphadenectomy, and hepaticojejunostomy.
There are a few previous reports that describe radical resection of very aggressive cases of what ultimately turned out to be xanthogranulomatous cholecystitis, and most describe little-to-no postoperative morbidity or mortality.
In xanthogranulomatous cholecystitis, mucin and bile are extravasated into subepithelial tissues and phagocytosed, resulting in inflammation, xanthoma formation, and processes of repair and fibrosis that, in some cases, produce pseudotumors that may be confused with malignancy.
For clinicians confronting similar cases, we recommend direct surgical intervention performed by an experienced hepatobiliary surgeon capable of removing all diseased tissue, reconstructing the patient’s anatomy, and effectively curing the patient of his or her disease process.