Incidental discovery of xanthogranulomatous cholecystitis as a mimicker of gall bladder adenocarcinoma: A retrospective cohort study.

Zeenat Sarmadi  Imam; Shadan  Rabab; Kumari Sunita  Bharti; Makarand Hemant  Langhe; Bipin  Kumar; Manish  Mandal; Rakesh Kumar  Singh

doi:10.51168/sjhrafrica.v6i6.1807

Authors

Zeenat Sarmadi Imam Associate Professor, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Shadan Rabab Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Kumari Sunita Bharti Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Makarand Hemant Langhe Senior Resident, Department of Surgical Gastroenterology and Liver Transplant, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Bipin Kumar Professor and HOD, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Manish Mandal Professor and HOD, Department of Surgical Gastroenterology and Liver Transplant, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Rakesh Kumar Singh Additional Professor, Department of Surgical Gastroenterology and Liver Transplant, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1807

Keywords:

Xanthogranulomatous Cholecystitis, Cholelithiasis, Gall bladder, Cholecystectomy

Abstract

Background

Xanthogranulomatous cholecystitis (XGC) is an inflammatory condition characterised by the intramural accumulation of lipid-laden macrophages in the bladder wall. Sometimes, XGC results in adhesions of the gall bladder to adjacent organs, causing the formation of fistulous tracts and bladder perforation. Intense adhesions lead to mass formation, giving a false impression of malignancy on radiological investigations and intraoperatively. Such cases are resolved only after final histopathological diagnosis, making it the gold standard.

Aims and Objectives: The study was conducted to outline and review the presentations and investigations in cases of XGC in order to structure an approach to managing diagnostic dilemmas in treating such patients.

Materials and methods

An observational, retrospective study was conducted in the Pathology department at IGIMS, Patna. A total of 1260 cholecystectomy samples with a preoperative diagnosis of gall bladder cancer (GBC), received from January 2019 to December 2024, were included in our study. Cases were selected as per the inclusion and exclusion criteria.

Results

Statistical analysis showed that out of 1260 specimens, preoperatively diagnosed as GBC, 59 were diagnosed as XGC on histopathological examination (Group X). Group Y had a greater incidence of anorexia and weight loss. Radiological findings on retrospect in group X displayed specific features suggestive of XGC, namely diffuse gall bladder wall thickening, hypoattenuated submucosal nodules, intrahepatic duct dilatation, continuous mucosal line enhancement, and loss of interface between the gall bladder and liver.

Conclusion

It is difficult to diagnose XGC from GBC preoperatively in all cases. Histopathological examination serves as the cornerstone in such diagnostic dilemmas.

Recommendations

A multidisciplinary approach and increased awareness are key to accurate diagnosis and appropriate management.

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