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.


中文翻译：

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拟似晚期胆囊癌的黄色肉芽肿性胆囊炎8例分析


背景/目的：黄色肉芽肿性胆囊炎（XGC）是一种罕见的破坏性胆囊炎性疾病。它经常被误诊为胆囊癌 (GBC)，因为它在临床表现、影像学和术中发现方面与后者相似，通常导致这些患者的手术切除范围扩大。本研究的目的是评估临床放射学诊断为 GBC 的 XGC 病例的诊断困境。
材料与方法： 2017年1月至2019年6月，组织病理学诊断为XGC的病例共8例，根据术前和术中发现误诊为GBC。收集和分析这些患者的临床特征、影像学、术中发现和手术数据。
结果：在研究期间，组织病理学科共收到 2154 份胆囊切除术标本。69例（3.2%）组织学诊断为XGC，其中8例（11.6%）术前诊断为GBC。这些病例主要见于 24-62 岁年龄段的男性。最常见的临床表现是慢性胆囊炎。8例均有胆结石。6 例影像学检查显示胆囊壁增厚的不均匀强化。7例术中观察到邻近器官粘连。所有这 8 例误诊为 GBC 的病例均接受了积极的手术治疗，随后组织病理学最终显示为 XGC。
结论：无论是临床表现还是实验室检查/放射学方法都不能提供区分 XGC 和 GBC 的有效方法。术前诊断很困难，组织病理学仍然是区分这两种疾病的金标准。