Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2016; 8(2): 183-191
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.183
Xanthogranulomatous cholecystitis: What every radiologist should know
Vaibhav P Singh, S Rajesh, Chhagan Bihari, Saloni N Desai, Sudheer S Pargewar, Ankur Arora
Vaibhav P Singh, S Rajesh, Saloni N Desai, Sudheer S Pargewar, Ankur Arora, Division of Diagnostic and Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, Delhi 110070, India
Chhagan Bihari, Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, Delhi110070, India
Author contributions: Singh VP, Desai SN and Pargewar SS contributed to this paper with conception and design of the study, literature review and analysis as well as drafting; Rajesh S, Bihari C and Arora A contributed to this paper with critical revision, editing and final approval of the final revision; Bihari C also provided with valuabe pathological inputs.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: S Rajesh, MD, PDCC, Assistant Professor, Division of Diagnostic and Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi, Delhi 110070, India.
Telephone: +91-78-38233499
Received: August 28, 2015
Peer-review started: September 18, 2015
First decision: October 30, 2015
Revised: November 8, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: February 28, 2016

Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

Keywords: Hypodense nodules, Carcinoma gallbladder, Xanthogranulomatous, Cholecystitis, Adenomyomatosis

Core tip: A pre-operative diagnosis of xanthogranulomatous cholecystitis always comes handy for the surgeons. Diagnosing atypical cases can be challenging and acknowledge of pathological changes occurring in the disease along with the spectrum of imaging findings can be a useful armoury in hands of the radiologist. So we have tried to give a concise review of this entity emphasizing on radiological and pathological aspects. Few points in differential diagnosing with other entities especially carcinoma gallbladder have also been entailed.