Fact-sheet: Xanthogranulomatous cholecystitis
Updated on 06/23/2020 at 8:51 AM
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Definition
Variant of chronic cholecystitis characterized by nodular fibro-edematous wall infiltration with:
- florid proliferation of foamy macrophages
- granulomatous reaction to bile released by rupture of Rokitansky-Aschoff sinuses (pseudo-diverticula of the gallbladder wall formed by mucosal evaginations into the muscularis and subserosal tissue, thought to result from endoluminal hyperpressure and often associated with gallstones)
Its occurrence may be explained by chronic infection, most often related to gallstones, with impaired bile drainage leading to bile extravasation into the wall, resulting in histiocyte accumulation and the development of micro-abscesses, which are subsequently replaced by xanthogranulomatous nodules.
A localized fibrous reaction may also be seen, accounting for the difficulty in differentiating it from a tumor.
Found in 4 to 9% of cholecystectomy specimens.
Most often associated with gallstones.
This condition does not increase the risk of cholangiocarcinoma, even though some cases show elevated CA 19-9 levels
Clinical features
Right upper quadrant pain
Sometimes jaundice
Fever
Laboratory findings
Hepatic cytolysis
Biological inflammatory syndrome
Ultrasound
Regular and nodular thickening of the gallbladder wall (hyperechoic, isoechoic, or hypoechoic), sometimes pseudocystic
Gallbladder stones
CT
May mimic gallbladder cancer
Regular and nodular thickening of the gallbladder wall, sometimes pseudocystic
Gallbladder stones
Infiltration of the pericholecystic fat
Look for possible complications (abscess, involvement of the extrahepatic bile ducts, inflammatory adhesion to the adjacent digestive tract...)
Differential diagnosis
Gallbladder adenocarcinoma
