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Lee SJ, Yang DM, Kim HC, Kim SW, Won KY, Park SH, Jeong WK. Imaging and Clinical Findings of Xanthogranulomatous Inflammatory Disease of Various Abdominal and Pelvic Organs: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:109-123. [PMID: 38362380 PMCID: PMC10864145 DOI: 10.3348/jksr.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 06/11/2023] [Indexed: 02/17/2024]
Abstract
Xanthogranulomatous (XG) inflammatory disease is a rare benign disease involving various organs, including the gallbladder, bile duct, pancreas, spleen, stomach, small bowel, colon, appendix, kidney, adrenal gland, urachus, urinary bladder, retroperitoneum, and female genital organs. The imaging features of XG inflammatory disease are nonspecific, usually presenting as a heterogeneous solid or cystic mass. The disease may also extend to adjacent structures. Due to its aggressive nature, it is occasionally misdiagnosed as a malignant neoplasm. Herein, we review the radiological features and clinical manifestations of XG inflammatory diseases in various organs of the abdomen and pelvis.
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Ambar N, Mans C, Gasper DJ. Antemortem Diagnosis and Successful Long-term Management of Disseminated Intracoelomic Xanthogranulomatous Disease in an Eclectus Parrot ( Eclectus roratus). J Avian Med Surg 2024; 37:330-338. [PMID: 38363165 DOI: 10.1647/2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A 12-year-old male eclectus parrot (Eclectus roratus) was referred for evaluation of coelomic distention. Computed tomography and blood work revealed coelomic effusion with free coelomic mineral-attenuating material and elevations in the bile acids and aspartate aminotransferase activity, respectively. Coelomic effusion was consistent with macrophagic inflammation with abundant intracellular lipids. Initial treatment with meloxicam resulted in minimal patient improvement. Disseminated xanthogranulomatous inflammation was suspected based on imaging and diagnostic laboratory results, which were consistent with those previously reported. Biopsy samples of liver tissue and intracoelomic masses confirmed this diagnosis. Treatment was initiated with prednisolone 1 mg/kg/d for 6 months, followed by 0.5 mg/kg/d for 3 months. Clinical improvement was assessed based on owner evaluation, plasma bile acid concentrations, and repeated computed tomographic scans. After 2 months of treatment, the owner reported improved behavior and appetite; this persisted throughout treatment and when the bird was reexamined 17 months following the cessation of steroid therapy. Bile acid concentrations were normal 10 months after the prednisolone therapy was discontinued. Diagnostic imaging showed minimal coelomic effusion 10 months after the last prednisolone dose was administered, with improved ventilation of the air sacs and static to improved dystrophic mineral foci. This report describes the antemortem diagnosis and treatment of disseminated coelomic xanthogranulomatous disease in a psittacine species, with an observed measurable therapeutic response.
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Affiliation(s)
- Neta Ambar
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA
| | - Christoph Mans
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA,
| | - David J Gasper
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA
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Huang EY, Reeves JJ, Broderick RC, Serra JL, Goldhaber NH, An JY, Fowler KJ, Hosseini M, Sandler BJ, Jacobsen GR, Horgan S, Clary BM. Distinguishing characteristics of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a persistent diagnostic dilemma. Surg Endosc 2024; 38:348-355. [PMID: 37783778 DOI: 10.1007/s00464-023-10461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis which can resemble gallbladder adenocarcinoma (GAC) on preoperative imaging and present technical challenges in the performance of cholecystectomy. We examined our experience with each pathology to identify distinguishing characteristics that may guide patient counseling and surgical management. METHODS A retrospective review of all pathologically confirmed cases of XGC and GAC following cholecystectomy between 2015 and 2021 at a single institution was performed. Clinical, biochemical, radiographic, and intraoperative features were compared. RESULTS There were 37 cases of XGC and 20 cases of GAC. Patients with GAC were older (mean 70.3 years vs 58.0, p = 0.01) and exclusively female (100% vs 45.9%, p < 0.0001). There were no significant differences in accompanying symptoms between groups (nausea/vomiting, fevers, or jaundice). The mean maximum white blood cell count was elevated for XGC compared to GAC (16.4 vs 8.6 respectively, p = 0.044); however, there were no differences in the remainder of the biochemical profile, including bilirubin, liver transaminases, CEA, and CA 19-9. The presence of an intraluminal mass (61.1% vs 9.1%, p = 0.0001) and lymphadenopathy (18.8%. vs 0.0%, p = 0.045) were associated with malignancy, whereas gallbladder wall thickening as reported on imaging (87.9% vs 38.9%, p = 0.0008) and gallstones (76.5% vs. 50.0%, p = 0.053) were more often present with XGC. Cases of XGC more often had significant adhesions/inflammation (83.8% vs 55.0%, p = 0.03). CONCLUSION Clinical features that may favor benign chronic cholecystitis over gallbladder adenocarcinoma include younger age, male gender, current or prior leukocytosis, and the absence of an intraluminal mass or lymphadenopathy. Laparoscopic cholecystectomy is a safe surgical option for equivocal presentations. Intraoperative frozen section or intentional staging of more extensive procedures based upon final histopathology are valuable surgical strategies.
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Affiliation(s)
- Estella Y Huang
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA.
| | - James J Reeves
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Joaquin L Serra
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Nicole H Goldhaber
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Julie Y An
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Mojgan Hosseini
- Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Bryan M Clary
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, San Diego, CA, USA
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Arnott W, Hutchins J, Malhotra T, Ketheesan Y, Steinberg L, Carter L, Diab J, Wong K. Xanthogranulomatous cholecystitis: diagnostic complexity and review of the literature. J Surg Case Rep 2023; 2023:rjad308. [PMID: 37337535 PMCID: PMC10276982 DOI: 10.1093/jscr/rjad308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
We report the case of a 39-year-old male presenting with acute onset vomiting and diarrhoea. Initially treated empirically for gastroenteritis, imaging later confirmed a complicated episode of cholecystitis with fistular formation and intra-abdominal cyst. Following cholecystectomy, histology confirmed a case of xanthogranulomatous cholecystitis (XGC). This paper presents a detailed summary of the condition alongside a literature review of all available episodes of XGC since 2017 with the aim of highlighting diagnostic conclusions regarding the nature of the disease and its clinical manifestations.
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Affiliation(s)
- William Arnott
- Correspondence address. The Tweed Hospital, Powell St, NSW, Australia. Tel: +61297228000; E-mail:
| | - Jemima Hutchins
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Tanishk Malhotra
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
| | - Yathurshika Ketheesan
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
| | - Lilly Steinberg
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
| | - Lucy Carter
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
| | - Jason Diab
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- John Flynn Private Hospital, Tugun, QLD, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - King Wong
- Department of General Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
- John Flynn Private Hospital, Tugun, QLD, Australia
- School of Medicine, Bond University, Robina, QLD, Australia
- School of Medicine, Griffith University, Southport, QLD, Australia
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Rana P, Gupta P, Kalage D, Soundararajan R, Kumar-M P, Dutta U. Grayscale ultrasonography findings for characterization of gallbladder wall thickening in non-acute setting: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:59-71. [PMID: 34826262 DOI: 10.1080/17474124.2021.2011210] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The accurate characterization of gallbladder wall thickening (GWT) into benign or malignant on ultrasound (US) is a significant challenge. METHODS We searched the MEDLINE and EMBASE databases for studies reporting two-dimensional grayscale US in benign and malignant GWT. The pooled prevalence was calculated using a generalized linear mixed method with a random-effects model. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. RESULTS Of the 7309 studies screened by titles, 73 studies with 18,008 patients were included. The most common findings in xanthogranulomatous cholecystitis (XGC) were lack of wall disruption and intramural hypoechoic nodules while adenomyomatosis (ADM) was frequently associated with intramural cysts and intramural echogenic foci. Echogenic foci, lack of gallbladder wall disruption, and hypoechoic nodules had a sensitivity of 89%, 77%, and 66% and specificity of 86%, 51%, and 80%, respectively for the diagnosis of benign GWT. Focal thickening and indistinct liver interface had a sensitivity of 75% and 55% and specificity of 64% and 69%, respectively for the diagnosis of malignant GWT. CONCLUSION intramural features (echogenic foci, hypoechoic nodules), gallbladder wall disruption, and liver interface are useful US features for the characterization of GWT.
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Affiliation(s)
- Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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ALTIOK M, KURT F. Effect of xanthogranulomatous cholecystitis on surgery. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.976851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Trisal M, Khan S, Husain M, Ahmad N, Hassan MJ, Jetley S. Recently Described Entity of Intracholecystic Papillary Neoplasm of Gallbladder with Coexisting Xanthogranulomatous Cholecystitis: an Unusual Association. Indian J Surg Oncol 2021; 12:308-311. [DOI: 10.1007/s13193-021-01400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
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Laparoscopic Management of Xanthogranulomatous Cholecystitis (XGC): a Diagnostic and Therapeutic Challenge to Surgeons in Northern India. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Khan S, Abeer I, Husain M, Hassan MJ, Jetley S. Xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma - Analysis of 8 cases. J Cancer Res Ther 2021; 17:969-975. [PMID: 34528550 DOI: 10.4103/jcrt.jcrt_1180_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background/Aim Xanthogranulomatous cholecystitis (XGC) is a rare destructive inflammatory disease of the gallbladder. It is frequently misdiagnosed as gallbladder carcinoma (GBC) as it mimics latter with regard to clinical manifestations, imaging and intraoperative findings, often leading to extended surgical resection in these patients. The aim of this study was to evaluate the diagnostic dilemma of XGC cases clinico-radiologically diagnosed with GBC. Materials and Methods From January 2017 to June 2019, a total of eight cases histopathologically diagnosed as XGC, were misdiagnosed with GBC based on preoperative and intra-operative findings. The clinical characteristics, imaging, intra-operative findings, and surgical data of these patients were collected and analyzed. Results A total of 2154 cholecystectomy specimens were received in the histopathology section during the study period. Sixty-nine cases (3.2%) were histologically diagnosed as XGC, of which 8 cases (11.6%) were preoperatively diagnosed with GBC. These cases were predominantly seen in males in the age range of 24-62 years. The most common clinical presentation was chronic cholecystitis. Gallstones were present in all the 8 cases. Six cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging. Intraoperatively, adhesions to adjacent organs were observed in seven cases. All these eight cases misdiagnosed with GBC underwent aggressive surgical treatment following which histopathology ultimately revealed XGC. Conclusion Neither clinical manifestations nor laboratory tests/radiological methods can provide an effective means of differentiating between XGC and GBC. Preoperative diagnosis is difficult, and histopathology remains the gold standard to differentiate the two entities.
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Affiliation(s)
- Sabina Khan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Inara Abeer
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Musharraf Husain
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mohd Jaseem Hassan
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Şimşek G, Şahin A, Hakan Metin Ş, Eşref Ulutaş M, Arslan K. The management of xanthogranulomatous cholecystitis. Turk J Surg 2021; 37:242-246. [DOI: 10.47717/turkjsurg.2021.5020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
Objective: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages.
Material and Methods: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients’ demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy.
Results: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p< 0.05). Total complication rate in XGC cases was 3.9%.
Conclusion: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.
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Azari FS, Kennedy GT, Bormann B, Braslow B, Tondon R, Lee K. A contemporary analysis of xanthogranulomatous cholecystitis in a Western cohort. Surgery 2021; 170:1317-1324. [PMID: 34147262 DOI: 10.1016/j.surg.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis is a particularly destructive variant of cholecystitis marked by unique inflammatory changes evident in pathologic specimens. Multiple case series have evaluated this process. However, these often focus on differentiating it from malignancy and have largely been conducted in Asia, where the disease may differ from that seen in the Western hemisphere. This study evaluated surgical outcomes after cholecystectomy for xanthogranulomatous cholecystitis at a high-volume tertiary care institution in the United States. The goal was to determine whether the process can be identified preoperatively and whether modifications should be made to the operative approach in this setting. METHODS Patients with histopathological confirmation of xanthogranulomatous cholecystitis who underwent cholecystectomy between 2002 and 2019 were identified from an updated institutional database. Data regarding demographics, imaging findings, surgical procedures, and perioperative complications were reviewed retrospectively. A cohort of patients undergoing cholecystectomy for more typical diagnoses was also identified for comparison. RESULTS Twenty-seven patients with a histopathologic diagnosis of xanthogranulomatous cholecystitis were identified. The median age was 64, and 17/27 (63.0%) were male. The majority of cases were done electively on patients admitted that day (17/27). Seventeen patients were evaluated with diagnostic ultrasonography, 21 with computed tomography scan, and 8 with magnetic resonance imaging; 21/27 patients had multiple modality studies. The most common singular finding was gallbladder wall thickening, but the radiographic findings were otherwise inconsistent. Twenty-five patients had planned laparoscopic cholecystectomies, but only 10 were completed. Only 8 of the 15 converted procedures were completed as simple cholecystectomies. Five patients required subtotal cholecystectomy. Median estimated blood loss was 250 cm3, and the median time of procedure was nearly 3 hours. Eight patients had complications, including 6 severe complications such as intraoperative bile duct injury. CONCLUSION Xanthogranulomatous cholecystitis unfortunately has a nonspecific presentation, which can make it difficult to recognize preoperatively. It is to be suspected in cases featuring a distended, severely inflamed gallbladder that does not match the benign appearance of the patient. When the diagnosis is suspected, an open approach is justified and patients should be counseled as to the increased likelihood of atypical approaches and elevated risk of complication. Referral to a hepatobiliary specialist is to be considered.
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Affiliation(s)
- Feredun S Azari
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Gregory T Kennedy
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Bradford Bormann
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Benjamin Braslow
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kenneth Lee
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
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Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 2021; 28:1011-1027. [PMID: 34110530 DOI: 10.1007/s10140-021-01944-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.
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Current update on gallbladder carcinoma. Abdom Radiol (NY) 2021; 46:2474-2489. [PMID: 33386907 DOI: 10.1007/s00261-020-02871-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Gallbladder (GB) carcinoma is a relatively rare malignancy and is associated with poor prognosis. Numerous risk factors have been associated with the development of GB carcinoma. GB carcinomas may present as mass lesions replacing the GB, focal or diffuse thickening of the GB wall, and intraluminal mass in the GB. Various benign conditions can mimic GB carcinoma. This article reviews the epidemiology, pathology, clinical findings, imaging features, and management of GB carcinomas.
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Ichikawa S, Oishi N, Kondo T, Onishi H. Key Imaging Findings for the Prospective Diagnosis of Rare Diseases of the Gallbladder and Cystic Duct. Korean J Radiol 2021; 22:1462-1474. [PMID: 34132078 PMCID: PMC8390821 DOI: 10.3348/kjr.2020.1479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
There are various diseases of the gallbladder and cystic duct, and imaging diagnosis is challenging for the rare among them. However, some rare diseases show characteristic imaging findings or patient history; therefore, familiarity with the imaging presentation of rare diseases may improve diagnostic accuracy and patient management. The purpose of this article is to describe the imaging findings of rare diseases of the gallbladder and cystic duct and identify their pathological correlations with these diseases.
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Affiliation(s)
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Japan
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How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound? Diagnostics (Basel) 2021; 11:diagnostics11050784. [PMID: 33926095 PMCID: PMC8145033 DOI: 10.3390/diagnostics11050784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022] Open
Abstract
The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.
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Frountzas M, Schizas D, Liatsou E, Economopoulos KP, Nikolaou C, Apostolou KG, Toutouzas KG, Felekouras E. Presentation and surgical management of xanthogranulomatous cholecystitis. Hepatobiliary Pancreat Dis Int 2021; 20:117-127. [PMID: 33536138 DOI: 10.1016/j.hbpd.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management. In addition, distinguishing XGC from gallbladder cancer preoperatively is still a challenge. The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC. DATA SOURCES The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases from inception until June 2020. RESULTS The laparoscopic cholecystectomy rate (34%) was almost equal to the open cholecystectomy rate (47%) for XGC. An important conversion rate (35%) was observed as well. The XGC cases treated by surgery were associated with low mortality (0.3%), limited intraoperative blood loss (58-270 mL), low complication rates (2%-6%), along with extended operative time (82.6-120 minutes for laparoscopic and 59.6-240 minutes for open cholecystectomy) and hospital stay (3-9 days after laparoscopic and 8.3-18 days after open cholecystectomy). Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome. In addition, complex surgical procedures, like wedge hepatic resections and bile duct excision were required during operations for XGC. CONCLUSIONS XGC seemed to be a rare, benign inflammatory disease that presents similar features as gallbladder cancer. The mortality and complication rates of XGC were low, despite the complex surgical procedures that might be required in some cases.
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Affiliation(s)
- Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, 114 Vas. Sofias Ave. 11527, Athens, Greece; Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, School of Medicine, 15B Ag. Thoma Str. 11527, Athens, Greece.
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece; Society of Junior Doctors, Surgery Workgroup, 75 Mikras Asias Str. 11527, Athens, Greece
| | - Efstathia Liatsou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece
| | - Konstantinos P Economopoulos
- Society of Junior Doctors, Surgery Workgroup, 75 Mikras Asias Str. 11527, Athens, Greece; Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27707, USA
| | - Christina Nikolaou
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, School of Medicine, 15B Ag. Thoma Str. 11527, Athens, Greece
| | - Konstantinos G Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece
| | - Konstantinos G Toutouzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, 114 Vas. Sofias Ave. 11527, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece
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17
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Feng L, You Z, Gou J, Liao E, Chen L. Xanthogranulomatous cholecystitis: experience in 100 cases. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1089. [PMID: 33145308 PMCID: PMC7575994 DOI: 10.21037/atm-20-5836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe foam cells and fibrosis, and can be an inducement of difficulty in cholecystectomy. The purpose of this study was to review the clinical findings and imageology features of XGC and to optimize the treatment option. Methods This retrospective study collected clinical symptoms, demographics, imageology, operation records, histopathological findings, and postoperative complications of 100 patients with XGC after evaluating 50005 cholecystectomy specimens between 2009 and 2018 in a single institute. heir clinical symptoms, demographics, imageology, operation records, histopathological findings, and postoperative complications were collected and analyzed. Results Patients showed various clinical symptoms, ultrasonography was performed in all patients, CT and MRI were further arranged selectively before the operation, but none of the patients were prediagnosed. Fifty-two patients received open cholecystectomy. Laparoscopic cholecystectomy (LC) was planned in 48 patients within whom 8 cases were converted to open cholecystectomy. No partial cholecystectomy was performed. The intraoperative findings included cholecystolithiasis, choledocholithiasis, thickened gallbladder wall, lesions infiltrating into adjacent tissues, disordered Calot’s triangle anatomy, enlarged regional lymph nodes, internal gallbladder fistula, and hepatic abscesses. Frozen-section analysis was performed in 48 patients under the suspicion of gallbladder carcinoma (GBCa), but only 2 cases were finally confirmed. Conclusions The preoperative diagnosis of XGC was challenging. Open cholecystectomy was the most preferred treatment, and conversion to open was often necessary after LC.
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Affiliation(s)
- Lei Feng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen You
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junhe Gou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Erwen Liao
- Department of General Surgery, Chengdu Longquan Xinchangkang Hospital, Chengdu, China
| | - Liping Chen
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
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18
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Güneş Y, Bostancı Ö, İlbar Tartar R, Battal M. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A 2020; 31:36-40. [PMID: 32559394 DOI: 10.1089/lap.2020.0334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder (GB). XGC surgery is a difficult process due to its clinical, radiological, and intraoperative findings. In this study, our aim is to show the difficulties of XGC surgery and to find out if laparoscopic surgery is a sufficient procedure. Materials and Methods: Histological findings of 3339 cholecystectomy patients, who were operated between January 2015 and January 2020, were retrospectively reviewed. Age, gender, radiological results, clinical features, intraoperative findings, and surgical management of the patients with XGC were recorded. Results: XGC was observed in 70 patients (2.09%). The average age was 53.75. M:F ratio was 1.2. In radiological examinations, gallstones were found in 94.2% of the patients and GB wall thickness (≥3 mm) was increased in 58.5% of the patients. Around 45.7% of the patients came to the clinic with chronic cholecystitis and 32.9% with acute cholecystitis. In the intraoperative period, adhesions were observed in 80% and increase in GB wall thickness was observed in 77.1% of the patients. The operation started laparoscopically in 66 patients. In 14 patients (21.2%), it was converted to open surgery usually due to insufficient dissection of Calot's triangle. Gallbladder carcinoma (GBC) was suspected in 6 patients, but none of them had malignancy in frozen sections or histology. Conclusions: XGC surgery is difficult due to its radiological, clinical, and intraoperative features and mimicking GBC. It can be converted to open cholecystectomy due to difficulties in laparoscopic dissection. However, since conversion cholecystectomy rates are reasonable, laparoscopic surgery is recommended in patients with suspected XGC.
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Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Özgür Bostancı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Rümeysa İlbar Tartar
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Muharrem Battal
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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19
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John S, Moyana T, Shabana W, Walsh C, McInnes MDF. Gallbladder Cancer: Imaging Appearance and Pitfalls in Diagnosis [Formula: see text]. Can Assoc Radiol J 2020; 71:448-458. [PMID: 32412302 DOI: 10.1177/0846537120923273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gallbladder cancer is an uncommon malignancy with an overall poor prognosis. The clinical and imaging presentation of gallbladder cancer often overlaps with benign disease, making diagnosis difficult. Gallbladder cancer is most easily diagnosed on imaging when it presents as a mass replacing the gallbladder. At this stage, the prognosis is usually poor. Recognizing the features of gallbladder cancer early in the disease can enable complete resection and improve prognosis. Recognition of the patterns of wall enhancement on computed tomography can help differentiate gallbladder cancer from benign disease. Gallbladder wall thickening without pericholecystic fluid presenting in an older patient with raised alkaline phosphatase should raise concern regarding gallbladder cancer. Gallbladder polyps in high-risk individuals need close surveillance or surgery as per guidelines. Small gallbladder cancers in the neck can present as biliary dilatation or cholecystitis, and careful examination of this area is needed to assess for lesion. The imaging appearance of gallbladder cancer is reviewed and supported by local institutional data. Features that differentiate it from its common mimics enabling earlier diagnosis are described.
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Affiliation(s)
- Susan John
- Department of Medical Imaging, 27337The Ottawa Hospital, Ontario, Canada.,27337The Ottawa Hospital Research Institute, Ontario, Canada
| | - Terence Moyana
- Department of Pathology and Laboratory Medicine, 6363University of Ottawa, Ontario, Canada.,Department of Anatomical Pathology, 27337The Ottawa Hospital, Ontario, Canada
| | - Wael Shabana
- Department of Medical Imaging, 27337The Ottawa Hospital, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada
| | - Cindy Walsh
- Department of Medical Imaging, 27337The Ottawa Hospital, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, 27337The Ottawa Hospital, Ontario, Canada.,27337The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada
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20
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Miyoshi H, Inui K, Katano Y, Tachi Y, Yamamoto S. B-mode ultrasonographic diagnosis in gallbladder wall thickening. J Med Ultrason (2001) 2020; 48:175-186. [PMID: 32333131 DOI: 10.1007/s10396-020-01018-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Diseases associated with gallbladder wall thickening include benign entities such as adenomyomatosis of the gallbladder, acute and chronic cholecystitis, and hyperplasia associated with pancreaticobiliary maljunction, and also cancer. Unique conditions such as sclerosing cholecystitis and cholecystitis associated with immune checkpoint inhibitor treatment can also manifest as wall thickening, as in some systemic inflammatory conditions. Gallbladder cancer, the most serious disease that can show wall thickening, can be difficult to diagnose early and to distinguish from benign causes of wall thickening, contributing to a poor prognosis. Differentiating between xanthogranulomatous cholecystitis and gallbladder cancer with wall thickening can be particularly problematic. Cancers that thicken the wall while coexisting with benign lesions that cause wall thickening represent another potential pitfall. In contrast, some benign gallbladder lesions that can cause wall thickening, such as adenomyomatosis and acute cholecystitis, typically show characteristic ultrasonographic features that, together with clinical findings, permit easier diagnosis. In this review of the literature, we describe B-mode abdominal ultrasonographic diagnosis of gallbladder lesions showing wall thickening.
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Affiliation(s)
- Hironao Miyoshi
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
| | - Kazuo Inui
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshiaki Katano
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshihiko Tachi
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Satoshi Yamamoto
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
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21
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Abstract
Hepatobiliary infections account for a small but clinically important proportion of emergency department presentations. They present a clinical challenge due to the broad range of imaging characteristics on presentation. Recognition of complications is imperative to drive appropriate patient care and resource utilization to avoid diagnostic pitfalls and avert adverse patient outcomes. A thorough understanding of anatomy infectious pathology of hepatobiliary system is essential in the emergency setting to confidently diagnose and guide medical intervention. Many presentations of hepatobiliary infection have characteristic imaging features on individual imaging modalities with others requiring the assimilation of findings of multiple imaging modalities along with incorporating the clinical context and multispecialist consultation. Familiarity with the strengths of individual imaging modalities in the radiologists' arsenal is imperative to guide the appropriate utilization of resources, particularly in the emergent time sensitive setting. Accurate identification and diagnosis of hepatobiliary infections is vital for appropriate patient care and management stratification.
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Affiliation(s)
- Daniel Hynes
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA.
| | - Christina Duffin
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA
| | - Tara Catanzano
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA
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22
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Domínguez‐Comesaña E, Tojo‐Artos I, Domínguez‐Fernández R, Rial‐Durán A, Tojo‐Ramallo S, Estevez‐Fernandez S. Xanthogranulomatous cholecystitis: A 14‐year experience. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Iria Tojo‐Artos
- Department of SurgeryPontevedra University Hospital Pontevedra Spain
| | | | - Agata Rial‐Durán
- Department of SurgeryPontevedra University Hospital Pontevedra Spain
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23
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Pandey A, Kumar D, Masood S, Chauhan S, Kumar S. Is Final Histopathological Examination the Only Diagnostic Criteria for Xanthogranulomatous Cholecystitis? Niger J Surg 2019; 25:177-182. [PMID: 31579373 PMCID: PMC6771184 DOI: 10.4103/njs.njs_1_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of gallbladder (GB) and can mimic GB cancer in extensive form. This study aims to assess the predictability of XGC on the basis of clinical presentation, laboratory tests, and radiological or intraoperative findings on frozen section analysis. Materials and Methods: This is a retrospective study, conducted over a period of 4 years from October 2013 to November 2017. In this study, all patients with histopathological reports of XGC, who underwent cholecystectomy or a radical cholecystectomy, were included. Clinical records of these patients were reviewed for clinical features, laboratory tests, and findings on radiological imaging. Results: Out of 700 consecutive cholecystectomies reviewed, 34 had histologically proven XGC (4.85%). Two patients had simultaneous presence of GB carcinoma with XGC. The most common presenting symptoms were right upper quadrant pain in 32 (94%) patients, jaundice in 9 (36%) patients, and fever in 5 (14%) patients. The most common radiological finding was cholelithiasis in 85.2% of cases. Thick-walled GB was present in 79.4% of patients; irregular wall thickening was present in 20.5% of patients. Intramural nodule was present in two patients, whereas hepatic invasion was observed in 11% and pericholecystic infiltration was present in 8.8% of patients. Regional lymphadenopathy was present in 9 (26.4%) patients. Conclusion: Clinical presentation and laboratory parameters were unequivocal due to considerable overlap. Despite recent advances in radiology, none have significant sensitivity and specificity to accurately diagnose XGC preoperatively. Intraoperative frozen section can add to the diagnosis with limited accuracy. The diagnosis of XGC can be confirmed only on histopathological examination.
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Affiliation(s)
- Anshuman Pandey
- Department of Surgical Gastroenterology, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Dinesh Kumar
- Department of Surgical Gastroenterology, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Shakeel Masood
- Department of Surgical Gastroenterology, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Smita Chauhan
- Department of Surgical Gastroenterology, RMLIMS, Lucknow, Uttar Pradesh, India
| | - Suneed Kumar
- Department of Surgical Gastroenterology, RMLIMS, Lucknow, Uttar Pradesh, India
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24
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Wasnik AP, Davenport MS, Kaza RK, Weadock WJ, Udager A, Keshavarzi N, Nan B, Maturen KE. Diagnostic accuracy of MDCT in differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis. Clin Imaging 2018; 50:223-228. [PMID: 29679780 DOI: 10.1016/j.clinimag.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of multi-detector CT (MDCT) for differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis using previously described imaging features. METHODS In this IRB approved HIPAA-compliant retrospective cohort study, contrast-enhanced MDCT of histologically confirmed acute cholecystitis (n = 17), xanthogranulomatous cholecystitis (n = 25), and gallbladder cancer (n = 18) were reviewed independently by three abdominal radiologists blinded to outcome. The primary outcome was the diagnostic accuracy of MDCT for the differentiation of gallbladder cancer from cholecystitis (acute and xanthogranulomatous) using various imaging parameters. Kappa (κ) statistics and two-way mixed-model single-measure intra-class correlation statistics (ICC) were calculated for each imaging feature and the final radiologic diagnosis. RESULTS Inter-rater agreement was moderate to substantial (κ = 0.43-0.70), sensitivity 0.67-0.78, specificity 0.22-0.33 and the positive likelihood ratio was 4.28-8.56 for the differentiation of gallbladder cancer from benign gallbladder pathology. Only three imaging findings: disrupted gallbladder mucosa (κ = 0.68), intraluminal gallstones (κ = 0.66), and gallbladder wall thickness (ICC = 0.63) had substantial inter-rater agreement. The following had slight or no agreement: intramural hypoattenuating nodules (κ = 0.17), transient hepatic attenuation differences (κ = 0.14), gallbladder wall calcification (κ = -0.01), gallbladder wall enhancement (κ = 0.18), and omental or mesenteric invasion (κ = 0.08). In the final multivariate model, the following were significant predictors useful in making or excluding diagnosis of gallbladder cancer: focal gallbladder wall thickening (p = 0.003, OR: 13.09 [95% CI: 2.40-71.48]), pericholecystic "fat stranding" (p = 0.018, OR: 0.10 [95% CI: 0.01-0.66]), and maximum short axis lymph node diameter (p = 0.043, OR: 1.18 [95% CI: 1.00-1.38]). CONCLUSION MDCT has moderate sensitivity, poor specificity, and moderate-to-substantial inter-rater repeatability for the differentiation of gallbladder cancer from acute and xanthogranulomatous cholecystitis.
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Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Mathew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - William J Weadock
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Aaron Udager
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Nahid Keshavarzi
- Michigan Institute of Clinical & Health Research (MICHR), University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Bin Nan
- Department of Statistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
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25
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Kishore R, Nundy S, Mehrotra S, Metha N, Mangla V, Lalwani S. Strategies for Differentiating Gallbladder Carcinoma from Xanthogranulomatous Cholecystitis-a Tertiary Care Centre Experience. Indian J Surg Oncol 2017; 8:554-559. [PMID: 29203989 DOI: 10.1007/s13193-017-0677-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/10/2017] [Indexed: 12/17/2022] Open
Abstract
Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gallbladder carcinoma (GBC) both preoperatively and intra-operatively, since it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of this misdiagnosis which is not infrequent, the patient may need to undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy which is associated with greater morbidity and mortality. Patients who underwent gallbladder and gallbladder-related operations during period of 5 years between 2010 and 2014 were reviewed (n = 462). A comparison of clinical, biochemical, radiological and operative features were made between patients with carcinoma gallbladder (n = 101) and xanthogranulomatous cholecystitis (n = 22). Patient with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gallbladder wall (p < 0.01), with cholelithiasis, choledocholithiasis and sub-mucosal hypoattenuated nodules (p < 0.05) are likely to have XGC while those with anorexia, weight loss, focal thickening of the gallbladder wall on imaging (p < 0.01) and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of fat plane interface between the liver and gallbladder are not differentiating factors. Differentiating XGC from GBC in preoperative setting is necessary to avoid radical procedures being done for a benign process. Certain clinical, radiological and intra-operative features aid in differentiating these benign and malignant process. However, the definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.
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Affiliation(s)
- Rajaguru Kishore
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Siddharth Mehrotra
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Naimish Metha
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailendra Lalwani
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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26
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Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc 2017; 31:5289-5294. [DOI: 10.1007/s00464-017-5604-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/16/2017] [Indexed: 01/27/2023]
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27
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Becker-Weidman D, Floré B, Mortelé KJ. Xanthogranulomatous pancreatitis: A review of the imaging characteristics of this rare and often misdiagnosed lesion of the pancreas. Clin Imaging 2017; 45:12-17. [PMID: 28554050 DOI: 10.1016/j.clinimag.2017.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
Xanthogranulomatous pancreatitis (XGP) is an extremely rare cause of a cystic pancreatic mass. The pathophysiology of this process is not entirely clear but likely results from a combination of duct obstruction, infection, and repeated hemorrhage. It is difficult to differentiate this inflammatory lesion from a cystic neoplasm and, therefore, in the majority of cases XGP is misdiagnosed as a neoplasm on preoperative imaging. In this report, we describe a case of XGP, the imaging characteristics of XGP, and a differential diagnosis for a cystic pancreatic lesion.
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Affiliation(s)
- David Becker-Weidman
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
| | - Bernard Floré
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| | - Koenraad J Mortelé
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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28
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Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses. AJR Am J Roentgenol 2017; 208:475-484. [PMID: 28095017 DOI: 10.2214/ajr.16.17075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Xanthogranulomatous (XG) processes are rare inflammatory conditions with the characteristic pathologic feature of lipid-laden macrophages or histiocyte cells. Imaging findings are nonspecific and can simulate aggressive neoplastic processes. XG processes can be caused by infection, inflammation, histolytic process, or an inherited lysosomal disorder. XG infectious processes are mainly seen in cholecystitis and pyelonephritis, but several other organs can also be involved. Histiocytic processes can be divided into Langerhans and non-Langerhans cell histiocytosis. The non-Langerhans cell histiocytosis entities include Erdheim-Chester disease, Rosai-Dorfman disease, juvenile xanthogranuloma, and hemophagocytic lymphohistiocytosis. The inherited lysosomal disorders resulting in XG processes include Nieman-Pick, Gaucher, and other lysosomal storage disorders. CONCLUSION Radiologists need to be able to recognize features of xanthogranulomatous processes to help facilitate patient management.
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Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma. ACTA ACUST UNITED AC 2016; 40:2281-92. [PMID: 25952571 DOI: 10.1007/s00261-015-0432-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate the diagnostic performance of HRUS, CT, and MRI for differentiating xanthogranulomatous cholecystitis (XGC) from gallbladder (GB) cancer. MATERIALS AND METHODS Patients with surgically proven XGC (n = 40) and GB cancer (n = 44), who had undergone at least one HRUS (n = 43), CT (n = 82), or MRI (n = 34) examination between 2000 and 2012, were included. Two radiologists retrospectively graded the likelihood of XGC or GB cancer using a 5-point confidence scale; they also assessed the imaging features. Statistical analyses were performed using ROC, ANOVA, and Fisher's exact test. RESULTS Diagnostic performance of MRI was better than HRUS for differentiating XGC from GB cancer (AUCs = 0.867 and 0.911 vs. AUCs = 0.818 and 0.86). However, HRUS showed a better performance than CT (AUCs = 0.818 and 0.86 vs. AUCs = 0.806 and 0.84) with moderate to excellent agreement (κ = 0.48-0.83). Statistically common findings for XGC included non-focal thickening, smooth GB wall, presence of intramural nodules, type I enhancement of wall, transient hepatic attenuation difference, and continuity of mucosa (p < 0.05). Co-existence of gallstones (OR = 16.5), non-focal thickening (OR = 14.7), and collapsed lumen (OR = 13.0) on HRUS, and type I enhancement on CT (OR = 3.52) were independently associated with XGC (p < 0.05). CONCLUSION Although MRI showed a better performance than both HRUS and CT, HRUS showed a better performance than CT. The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.
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Sunnapwar A, Menias CO, Ojili V, Policarpio Nicolas M, Katre R, Gangadhar K, Nagar A. Abdominal manifestations of histiocytic disorders in adults: imaging perspective. Br J Radiol 2016; 89:20160221. [PMID: 27332519 DOI: 10.1259/bjr.20160221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histiocytic disorders (HDs) are a diverse group of diseases characterized by pathologic infiltration of normal tissues by cells of the mononuclear phagocyte system. The spectrum of these diseases ranges from treatable infectious diseases to rapidly progressive, life-threatening conditions. Although they are rare and difficult diagnoses, HDs can be diagnosed with the help of clinical and laboratory analyses, imaging features and tissue biopsy. The clinicopathology and imaging spectrum of select entities belonging to this disorder are presented in this review.
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Affiliation(s)
- Abhijit Sunnapwar
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Vijaynadh Ojili
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Rashmi Katre
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Arpit Nagar
- 4 Ohio State University, Wexner Medical Center, Columbus, OH, USA
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Yucel O, Uzun MA, Tilki M, Alkan S, Kilicoglu ZG, Goret CC. Xanthogranulomatous Cholecystitis: Analysis of 108 Patients. Indian J Surg 2016; 79:510-514. [PMID: 29217901 DOI: 10.1007/s12262-016-1511-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/26/2016] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to evaluate the clinical and radiological features of xanthogranulomatous cholecystitis (XGC) and the results of surgical treatment. This retrospective study concerns clinical, radiological, and surgical data as well as histopathological findings and postoperative results of 108 patients with XGC who were identified after evaluating 7916 cholecystectomy specimens between 2004 and 2014 in a single institute. One hundred eight patients with XGC were evaluated (56 males and 52 females, mean age 62.3 years). Clinical findings at referral included acute and chronic cholecystitis, Mirizzi's syndrome, choledocholithiasis, cholangitis, and acute pancreatitis. Ultrasound was performed in all patients, CT in 25, contrast-enhanced MRI in 29, and magnetic resonance cholangiopancreatography (MRCP) in 25 patients. None of the patients were diagnosed preoperatively, but mild-moderate degrees of wall thickening were present in most. Fifty-four patients received open cholecystectomy, while 54 received laparoscopic intervention, among whom 23 were converted to open. Partial cholecystectomy was performed in 11 patients. Two patients with gallbladder adenocarcinoma were treated with radical cholecystectomy. XGC has nonspecific clinical and radiological findings; thus, preoperative diagnosis is generally absent. Open cholecystectomy is the recommended treatment modality. Conversion to open is frequently necessary after laparoscopy. Complete cholecystectomy is the ultimate goal; however, partial cholecystectomy may be preferred to protect the structures of the hepatic hilum.
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Affiliation(s)
- Osman Yucel
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 23, Uskudar, Istanbul, Turkey
- Semsettin Gunaltay Cad. No: 159/36, Erenkoy, Kadikoy, Istanbul, Turkey
| | - Mehmet Ali Uzun
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 23, Uskudar, Istanbul, Turkey
| | - Metin Tilki
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 23, Uskudar, Istanbul, Turkey
| | - Sevcan Alkan
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 23, Uskudar, Istanbul, Turkey
| | - Zeynep Gamze Kilicoglu
- Department of Radiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ceren Canbey Goret
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Abstract
Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.
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Suzuki H, Wada S, Araki K, Kubo N, Watanabe A, Tsukagoshi M, Kuwano H. Xanthogranulomatous cholecystitis: Difficulty in differentiating from gallbladder cancer. World J Gastroenterol 2015; 21:10166-10173. [PMID: 26401081 PMCID: PMC4572797 DOI: 10.3748/wjg.v21.i35.10166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/13/2015] [Accepted: 07/18/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare cases of xanthogranulomatous cholecystitis (XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.
METHODS: From April 2000 to December 2013, 6 XGC patients received extended surgical resections. During the same period, 16 patients were proven to have gallbladder (GB) cancer, according to extended surgical resection. Subjects chosen for analysis in this study were restricted to cases of XGC with indistinct borders with the liver as it is often difficult to distinguish these patients from those with advanced GB cancer. We compared the clinical features and computed tomography findings between XGC and advanced GB cancer. The following clinical features were retrospectively assessed: age, gender, symptoms, and tumor markers. As albumin and the neutrophil/lymphocyte ratio (NLR) are prognostic in several cancers, we compared serum albumin levels and the NLR between the two groups. The computerized tomography findings were used to compare the two diseases, determine the coexistence of gallstones, the pattern of GB thickening (focal or diffuse), the presence of a hypoattenuated intramural nodule, and continuity of the mucosal line.
RESULTS: Based on the preoperative image findings, we suspected GB carcinoma in all cases including XGC in this series. In addition, by pathological examination, we found that the group of patients with XGC developed inflammatory disease after surgery. Patients with XGC tended to have abdominal pain (4/6, 67%). However, there was no significant difference in clinical symptoms, including fever, between the two groups. Serum albumin and NLR were also similar in the two groups. Serum tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), tended to increase in patients with GB cancer. However, no significant differences in tumor markers were identified. On the other hand, gallstones were more frequently observed in patients with XGC (5/6, 83%) than in patients with GB cancer (4/16, 33%) (P = 0.0116). A hypoattenuated intramural nodule was found in 3 patients with XGC (3/6, 50%), but in only 1 patient with GB cancer (1/16, 6%) (P = 0.0024). The GB thickness, continuous mucosal line, and bile duct dilatation showed no significant differences between XGC and GB cancer.
CONCLUSION: Although XGC is often difficult to differentiate from GB carcinoma, it is possible to obtain an accurate diagnosis by careful intraoperative gross observation, and several intraoperative frozen sections.
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Qasaimeh GR, Matalqah I, Bakkar S, Al Omari A, Qasaimeh M. Xanthogranulomatous cholecystitis in the laparoscopic era is still a challenging disease. J Gastrointest Surg 2015; 19:1036-42. [PMID: 25895976 DOI: 10.1007/s11605-015-2818-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/01/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis is an unusual inflammatory process of the gallbladder which is difficult to diagnose and manage and may be confused with gallbladder cancer. Many surgeons and pathologists are not familiar with this condition. We aim to highlight this condition and to review the role of laparoscopy in its management. PATIENTS AND METHODS We reviewed the records of 4406 patients who underwent cholecystectomy in 8 years at two teaching hospitals in North Jordan. Forty-two cases of Xanthogranulomatous cholecystitis were identified. The details of these patients were analyzed. The findings were compared with results of a previous study in all cholecystectomy patients conducted in the same centers. RESULTS The incidence of Xanthogranulomatous cholecystitis was 0.95 %. Twenty-five patients (59.5 %) presented as acute emergencies. Nine patients (21.4 %) had jaundice. Ultrasound showed marked gallbladder wall thickening in 36 patients (85.7 %). Compared with all cholecystectomy patients, xanthogranulomatous cholecystitis patients showed higher conversion rate from laparoscopic to open cholecystectomy (31.4 vs. 3.2 %, p < 0.001) and higher morbidity (33.3 vs. 6.4 % p < 0.001). CONCLUSIONS Xanthogranulomatous cholecystitis is rare. Acute presentation, associated jaundice, and gallbladder wall thickening should raise the suspicion of the condition. Laparoscopic cholecystectomy is associated with high conversion rate.
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Expression of GLUT-1 and GLUT-3 in xanthogranulomatous cholecystitis induced a positive result on ¹⁸F-FDG PET: report of a case. Int Surg 2015; 98:372-8. [PMID: 24229026 DOI: 10.9738/intsurg-d-13-00092.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although several reports have revealed that fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is useful for differentiating between benign and malignant lesions in the gallbladder, the positive results of (18)F-FDG PET are not specific for malignancy because (18)F-FDG is also accumulated in inflammatory lesions. It is known that the most important pathway for (18)F-FDG to enter the cell body is mediated by the facilitative glucose transporter-1 (GLUT-1) through GLUT-3. We herein present a case of xanthogranulomatous cholecystitis (XGC) with a positive result on (18)F-FDG PET. In this case, GLUT-1 and GLUT-3 were both positively expressed in inflammatory cells at the gallbladder wall of XGC and this is the first report to reveal GLUT expression in XGC. This report reveals that surgeons should carefully consider the appropriate treatment of gallbladder tumor, even with a positive result on (18)F-FDG PET.
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Tsai LL, Kaliannan K, Mortele KJ. Gallbladder splenosis: a hereto unreported mimicker of a gallbladder neoplasm. Clin Imaging 2014; 39:318-20. [PMID: 25467423 DOI: 10.1016/j.clinimag.2014.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Abstract
Splenosis is a completely benign entity that can mimic a primary mass or metastasis. Herein we report the first known case of gallbladder splenosis in a 49-year-old woman with an extensive surgical and medical history. Cross-sectional computed tomography and MRI demonstrated a single mass arising from the gallbladder fundus. Revelation of splenectomy, confirmed to be traumatic from medical records, raised the suspicion for splenosis. The diagnosis was confirmed with a Technecium-99m-labeled heat-damaged blood cell scan, considered the gold-standard for detection of ectopic splenic tissue.
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Affiliation(s)
- Leo L Tsai
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
| | - Krithica Kaliannan
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
| | - Koenraad J Mortele
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
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Xanthogranulomatous cholecystitis masquerading as gallbladder cancer: can it be diagnosed preoperatively? Gastroenterol Res Pract 2014; 2014:253645. [PMID: 25404941 PMCID: PMC4227324 DOI: 10.1155/2014/253645] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 12/21/2022] Open
Abstract
Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.
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Revzin MV, Scoutt L, Smitaman E, Israel GM. The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. ACTA ACUST UNITED AC 2014; 40:385-99. [DOI: 10.1007/s00261-014-0203-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ewelukwa O, Ali O, Akram S. Xanthogranulomatous cholecystitis mimicking gallbladder cancer. BMJ Case Rep 2014; 2014:bcr-2013-200530. [PMID: 24811556 DOI: 10.1136/bcr-2013-200530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.
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Affiliation(s)
- Ofor Ewelukwa
- Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
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40
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Hale MD, Roberts KJ, Hodson J, Scott N, Sheridan M, Toogood GJ. Xanthogranulomatous cholecystitis: a European and global perspective. HPB (Oxford) 2014; 16:448-58. [PMID: 23991684 PMCID: PMC4008163 DOI: 10.1111/hpb.12152] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/26/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Xanthogranulomatous cholecystitis (XGC) is often mistaken for, and may predispose to, gallbladder carcinoma (GB Ca). This study reviews the worldwide variation of the incidence, investigations, management and outcome of patients with XGC. METHODS Data from 29 studies, cumulatively containing 1599 patients, were reviewed and results summarized by geographical region (Europe, India, Far East and Americas) with 95% confidence intervals (CIs) to present variability within regions. The main study outcomes were incidence, association with GB Ca and treatment of patients with XGC. RESULTS Overall, the incidence of XGC was 1.3-1.9%, with the exception of India where it was 8.8%. The incidence of GB Ca associated with XGC was lowest in European studies (3.3%) varying from 5.1-5.9% in the remaining regions. Confusion with or undiagnosed GB Ca led to 10.2% of patients receiving over or under treatment. CONCLUSIONS XGC is a global disease and is associated with GB Ca. Characteristic pathological, radiological and clinical features are shared with GB Ca and contribute to considerable treatment inaccuracy. Tissue sampling by pre-operative endoscopic ultrasound or intra-operative frozen section is required to accurately diagnose gallbladder pathology and should be performed before any extensive resection is performed.
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Affiliation(s)
- Matthew David Hale
- University of Leeds Medical SchoolLeeds,Correspondence Matthew David Hale, University of Leeds Medical School, Leeds, LS2 9JT, UK. Tel: 07950886979. E-mail:
| | | | - James Hodson
- Wolfson Computer Lab, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation TrustBirmingham
| | - Nigel Scott
- Department of Pathology, St James's University HospitalLeeds, UK
| | - Maria Sheridan
- Department of Hepatobiliary and Pancreatic Radiology, St James's University HospitalLeeds, UK
| | - Giles J Toogood
- Department of Hepatobiliary and Transplant Surgery, St James's University HospitalLeeds, UK
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Abstract
On computed tomography (CT), gallbladder pathology may be detected incidentally or as the etiology of symptoms that prompted imaging. Accurate pathologic diagnosis can be challenging, however, due to overlapping appearances of malignant and benign gallbladder disease. This pictorial essay takes a pattern-based approach to CT of the gallbladder, to help the radiologist formulate the proper differential diagnosis.
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Agarwal AK, Kalayarasan R, Javed A, Sakhuja P. Mass-forming xanthogranulomatous cholecystitis masquerading as gallbladder cancer. J Gastrointest Surg 2013; 17:1257-64. [PMID: 23615807 DOI: 10.1007/s11605-013-2209-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mass-forming xanthogranulomatous cholecystitis (XGC), an uncommon inflammatory pathology of gallbladder (GB), masquerades as gallbladder cancer (GBC) and diagnosis is often a histological surprise. METHODS A retrospective analysis of prospectively collected database of patients with GB mass operated between August 2009 and September 2012 was conducted to determine clinical, radiological, and intraoperative findings that might aid in the preoperative diagnosis of mass-forming XGC and ascertain their optimal management strategy. RESULTS Of the 566 patients with GB mass and suspected GBC, 239 were found to be inoperable on preoperative workup and 129 patients had unresectable disease on staging laparoscopy/laparotomy. Of the 198 with resectable disease, 31 were reported as XGC on final histopathology (Group A), while 167 were GBC (Group B). Of these 31 patients, six with an intraoperative suspicion of benign pathology underwent cholecystectomy with segments IVb and V resection, and frozen section histopathology. Twenty-five underwent radical cholecystectomy, with (n = 10) or without (n = 15) adjacent organ resection. In comparison, anorexia and weight loss were significantly more in Group B (p = 0.001 and <0.001). Intraoperatively, empyema and associated gallstones were more common in Group A (p = 0.011 and <0.001). On computed tomography (CT) of the abdomen, continuous mucosal line enhancement and intramural hypodense bands were significantly more in Group A (p < 0.001 and 0.025). While CT abdomen revealed one or more features suggestive of XGC in 64.5 % (20/31) of patients in Group A, 11(35.5 %) did not have any findings suggestive of XGC on imaging. CONCLUSION Mass-forming XGC mimics GBC, making preoperative and intraoperative distinction difficult. While imaging findings can help in suspecting XGC, definitive diagnosis require histopathological examination. Presence of typical radiological findings, however, can help in avoiding extended radical resection in selected cases.
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Zhao F, Lu PX, Yan SX, Wang GF, Yuan J, Zhang SZ, Wang YXJ. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases. Eur J Radiol 2013; 82:1391-7. [PMID: 23726123 DOI: 10.1016/j.ejrad.2013.04.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To study the CT and MR features of xanthogranulomatous cholecystitis (XGC). MATERIALS AND METHODS 49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed. RESULTS On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥ 4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n=3), stomach (n=2), and abdominal wall (n=1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images. CONCLUSION Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall.
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Affiliation(s)
- Feng Zhao
- Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
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A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret's Syndrome. Case Rep Radiol 2012; 2012:402768. [PMID: 23346444 PMCID: PMC3546451 DOI: 10.1155/2012/402768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/08/2012] [Indexed: 12/24/2022] Open
Abstract
The purpose of this paper is to present sonographic and CT imaging findings of xanthogranulomatous cholecystitis (XGC) presented as Bouveret's syndrome, a very rare cause of gastric obstruction. While the patient's physical examination, upper GI endoscopy, and radiological findings all pointed to Bouveret's syndrome, CT differential diagnosis suggested either XGC or gallbladder carcinoma, and the final diagnosis was done histopathologically. Our paper aims to increase awareness in radiologically diagnosing XGC cases by introducing the possibility of existence of Bouveret's syndrome.
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Al-Abed Y, Elsherif M, Firth J, Borgstein R, Myint F. Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm. Korean J Intern Med 2012; 27:338-41. [PMID: 23019399 PMCID: PMC3443727 DOI: 10.3904/kjim.2012.27.3.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/11/2010] [Accepted: 10/18/2010] [Indexed: 11/27/2022] Open
Abstract
There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.
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Affiliation(s)
- Yahya Al-Abed
- Department of Surgery, North Middlesex University Hospital, London, UK.
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Diagnosis and Treatment of Xanthogranulomatous Cholecystitis: A Report of 39 Cases. Cell Biochem Biophys 2012; 64:131-5. [DOI: 10.1007/s12013-012-9381-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Psarras K, Baltatzis ME, Symeonidis N, Pavlidis ET, Miha A, Pavlidis TE, Sakantamis AK. A severe case of xanthogranulomatous cholecystitis along with a review of CT indications for nonoperative management including percutaneous drainage. Surg Laparosc Endosc Percutan Tech 2012; 22:e42-4. [PMID: 22318078 DOI: 10.1097/sle.0b013e318241bf29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis is a rare but severe presentation of cholecystitis characterized by extensive inflammation of the gallbladder wall with characteristic histopathological features. Frequently, the inflammatory mass resembles gallbladder cancer macroscopically, which further complicates therapeutic decisions. CASE PRESENTATION We report a case of xathogranulomatous cholecystitis with characteristic computed tomography findings, which was managed by percutaneous drainage of the gallbladder, giving the opportunity for a delayed elective cholocystectomy with an excellent postoperative outcome. DISCUSSION Recent studies give emphasis on certain criteria for the differential diagnosis of xanthogranulomatous cholecystitis against carcinoma. Characteristic computed tomography features are usually sufficient to establish the diagnosis with safety and decide a nonoperative management of the disease in the acute phase. Percutaneous gallbladder drainage is regarded as a safe and an efficient method for the initial treatment of severe cases.
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Affiliation(s)
- Kyriakos Psarras
- Propedeutical Department of Surgery, Medical School, Aristotle University, Hippokrateion Hospital, Thessaloniki, Greece.
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Ahn YJ, Kim TH, Moon SW, Choi SN, Kim HJ, Jung WT, Lee OJ, Ko GH. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 58:153-6. [PMID: 21960104 DOI: 10.4166/kjg.2011.58.3.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.
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Affiliation(s)
- Yeon Jeong Ahn
- Departments of Internal Medicine, Pathology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Barbosa ABR, Souza LRMFD, Pereira RS, D'Ippolito G. Espessamento parietal da vesícula biliar no exame ultrassonográfico: como interpretar? Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000600010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo desta revisão é fornecer auxílio na interpretação correta do espessamento das paredes da vesícula biliar e seus possíveis diagnósticos diferenciais. O espessamento da vesícula biliar é um achado frequente em exame de ultrassonografia e um tema de grande interesse, por ter sido considerado durante muito tempo como sinal específico de colecistite aguda, apesar de se reconhecer que ocorre em uma série de outras situações clínicas. A adequada caracterização e interpretação desse achado é de grande importância, pois o diagnóstico correto tem impacto direto no tratamento, que em alguns casos inclui intervenção cirúrgica. Neste artigo procuramos apresentar um conjunto de sinais ultrassonográficos que, associados ao quadro clínico e laboratorial do paciente, permitem restringir as alternativas diagnósticas e estabelecer, com maior precisão, a causa do espessamento parietal da vesícula biliar, através de uma avaliação racional dos dados obtidos.
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Cecava ND, Andrews R. Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology. J Radiol Case Rep 2011; 5:19-24. [PMID: 22470787 DOI: 10.3941/jrcr.v5i4.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A case of xanthogranulomatous cholecystitis is presented with a brief review of its sonographic and magnetic resonance features. These imaging features are also compared to those seen in gallbladder adenomyomatosis and gallbladder carcinoma. While there are many overlapping imaging findings in these entities, it is important to recognize distinguishing characteristics so a correct surgical approach is chosen. Laparoscopic cholecystectomy attempted with existing xanthogranulomatous cholecystitis has an increased surgical complication rate compared to open cholecystectomy and often necessitates intraoperative conversion to open cholecystectomy.
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Affiliation(s)
- Nathan D Cecava
- Department of Radiology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA.
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