Ottavia Cicerone, Luigi Colletto, Benedetta Pellizzari, Asia Ciuffardi, Himeth Devnaka Samarawickrama Kodikarage, Mario Tushe, Gioacchino D’Ambrosio, Alessandro Vanoli, Marcello Maestri
Ottavia Cicerone, Luigi Colletto, Benedetta Pellizzari, Asia Ciuffardi, Himeth Devnaka Samarawickrama Kodikarage, Marcello Maestri, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia 27100, Italy
Ottavia Cicerone, Luigi Colletto, Benedetta Pellizzari, Asia Ciuffardi, Marcello Maestri, General Surgery Unit I, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
Mario Tushe, Alessandro Vanoli, Department of Molecular Medicine, University of Pavia, Pavia 27100, Italy
Mario Tushe, Gioacchino D’Ambrosio, Alessandro Vanoli, Department of Pathological Anatomy, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
Author contributions: Cicerone O, Colletto L, Pellizzari B, Ciuffardi A, and Samarawickrama Kodikarage HD contributed to writing of original draft; Tushe M, D’Ambrosio G, and Vanoli A contributed to figure preparation and reference screening; Vanoli A and Maestri M contributed to writing - review and editing; Cicerone O and Maestri M contributed to conceptualization and study design; Maestri M contributed to project administration. All authors approved the final version to publish.
AI contribution statement: A large language model was used to assist with language editing and improve readability (ChatGPT).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Marcello Maestri, MD, PhD, Professor, General Surgery Unit I, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, Pavia 27100, Italy. m.maestri@smatteo.pv.it
Received: July 14, 2026 Revised: August 10, 2026 Accepted: September 21, 2026 Published online: November 27, 2026 Processing time: 123 Days and 10.1 Hours
Abstract
Xanthogranulomatous cholecystitis (XGC) is a rare benign inflammatory disorder that can closely resemble gallbladder carcinoma (GBC) clinically, radiologically, intraoperatively, and even on gross pathological examination. This overlap may lead to both unnecessary radical surgery and undertreatment of unsuspected malignancy. This review summarizes the contemporary literature together with institutional clinical and radiological experience, focusing on diagnostic pitfalls and practical surgical decision-making. Two illustrative cases are also presented. Reliable preoperative differentiation between XGC and GBC remains difficult because symptoms, laboratory findings, tumor markers, and individual imaging features overlap considerably. A pattern-based interpretation of computed tomography and magnetic resonance imaging findings may improve diagnostic confidence. Diffuse wall thickening, continuous mucosal enhancement, intramural hypoattenuating or T2-hyperintense nodules, gallstones, and preservation of the mural architecture tend to favor XGC, whereas focal mass formation, mucosal disruption, biliary obstruction, lymphadenopathy, and convincing hepatic invasion raise greater concern for GBC. Machine-learning and deep-learning models have shown promising diagnostic performance, although external validation and improved interpretability are still required before they can be incorporated into routine clinical practice. Frozen-section analysis, careful nodal assessment, and delayed oncologic resection after definitive histological assessment when uncertainty persists may provide a reasonable balance between avoiding unnecessary radical procedures and preventing undertreatment of true malignancy.
Core Tip: Xanthogranulomatous cholecystitis is a benign inflammatory disease that may closely mimic gallbladder carcinoma, creating a risk of either unnecessary radical surgery or delayed cancer treatment. No single clinical, laboratory, or imaging feature reliably separates the two conditions. Diagnostic confidence improves when clinical findings and multimodal imaging features are interpreted. Frozen-section analysis, nodal assessment, safe cholecystectomy with early conversion or bail-out procedures when necessary and delayed oncologic resection after definitive histological assessment in unresolved cases may offer the best compromise between oncologic adequacy and avoidance of overtreatment.
