Xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis ( Figure 71.30 ) is an uncommon inflammation of the gallbladder, more frequently seen in India and Japan. It is more common in females. - It is caused by extravasation of bile into the gallbladder wall from rupture of the Rokitansky–Ascho ff sinuses or by mucosal ulceration as a result of a focal or di ff use destructive - inflammatory process, with accumulation of lipid-laden macrophages (xanthoma cells), fibrous tissue and acute and chronic inflammatory cells. USG shows gallbladder wall intramural hypoechoic nodules or bands and often the presence of gallstones. CT shows 5- to 20-mm intramural hypoattenuating nodules and poor/heterogeneous contrast enhancement. As with acute cholecystitis, early enhancement of the adjacent liver parenchyma may occur. Extension into the liver along with enlarged hepatoduodenal lymph nodes closely mimics gallbladder carcinoma. Diagnosis is di ffi cult and depends on pathological examination. Intraoperatively , frozen-section examination should be carried out to di ff erentiate xanthogranulomatous cholecystitis from carcinoma of the gallbladder (coexistence of gallbladder cancer 2.3–13.3%). Because of diagnostic di ffi culties if there is preoperative suspicion of xanthogranulomatous cholecystitis open cholecystectomy should be considered.