Analysis of Diagnosis and Treatment of Xanthogranulomatous Cholecystitis in 48 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GONGHai-yan ¹ , GEWei ² , JIANGSong-song ² ,  CHENGang ²

1. Department of Physical Examination Center, Nanjing Drum-Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China;
2. Department of General Surgery, Nanjing Drum-Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China;

Corresponding author：

CHENGang, Email: gulou_hospital@163.com

Keywords：

Xanthogranulomatous cholecystitis; Diagnosis; Treatment

DOI：

10.7507/1007-9424.20140242

Video：

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Objective To explore the etiological agent, clinical manifestations, imaging findings, pathologic characteristics, diagnosis, treatment, and prognosis of xanthogranulomatous cholecystitis(XGC). Method The clinical data of 48 patients with XGC diagnosed by postoperative pathology from January 2003 to December 2012 were collected and analyzed. Results In these 48 patients with XGC, the clinical manifestations included 40(83.3%)patients with upper right abdominal pain, 18(37.5%)patients with jaundice, 12(25.0%)patients with fever. B ultrasound examination was performed in 45 cases, in which 42 cases were diagnosed with cholecystitis, 38 cases together with cholecystolithiasis, 15 cases together with cholecystolithiasis and gallbladder neoplasm, and 3 cases together with choledocholith with bile duct dilatation. CT was performed in 30 cases, in which 25 cases were diagnosed with cholecystitis together with cholecystolithiasis, 11 cases were diagnosed with gallbladder neoplasm. MRI was performed in 22 cases, in which 18 cases were diagnosed with cholecystitis together with cholecystolithiasis, 4 cases were diagnosed with gallbladder carcinoma. Thirty-three cases were treated with open cholecystectomy, 9 patients with laparoscopic cholecystectomy, 4 patients with cholecystectomy plus choledocholithotomy and T-tube drainage, 2 patients with cholecystectomy plus partial hepatectomy. All the patients were diagnosed with XGC by postoperative pathology and recovered well without recurrence and canceration. Conclusions XGC is a kind of benign and invasive disease without specific clinical manifestation. Bultrasound, CT, or MRI play an important role in diagnosis, but final diagnosis is mainly based on pathological detection, and surgery is the most effective treatment. The prognosis of XGC is favorable if gallbladder is completely resected.

Citation： GONGHai-yan, GEWei, JIANGSong-song, CHENGang. Analysis of Diagnosis and Treatment of Xanthogranulomatous Cholecystitis in 48 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1009-1012. doi: 10.7507/1007-9424.20140242 Copy

1.	McCoy JJ Jr, Vila R, Petrossian G, et al. Xanthogranulomatous cholecystitis. Report of two cases[J]. J S C Med Assoc, 1976, 72(3): 78-79.
2.	Guzmán-Valdivia G. Xanthogranulomatous cholecystitis in laparoscopic surgery[J]. J Gastrointest Surg, 2005, 9(4): 494-497.
3.	Goodman ZD, Ishak KG. Xanthogranulomatous cholecystitis[J]. Am J Surg Pathol, 1981, 5(7): 653-659.
4.	张旭日, 崔乃强, 赵二鹏, 等. 45例黄色肉芽肿性胆囊炎临床治疗分析[J].中国中西医结合外科杂志, 2011, 17(4): 352-354.
5.	Han SH, Chen Yl. Diagnosis and treatment of xanthogranulomatous cholecystitis: a report of 39 cases[J]. Cell Biochem Biophys, 2012, 64(2): 131-135.
6.	Zhao F, lu PX, Yan SX, et al. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases[J]. Eur J Radiol, 2013, 82(9): 1391-1397.
7.	Uchiyama K, Ozawa S, Ueno M, et al. Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma[J]. J Hepatobiliary Pancreat Surg, 2009, 16(3): 333-338.
8.	Jain S, Saluja SS, Sharma AK, et al. Xanthogranulomatous cholecystitis: catching the culprit-clinical and imaging analysis[J]. Dig Surg, 2012, 29(3): 187-193.
9.	Cui Y, Zhang H, Zhao E, et al. Differential diagnosis and treatment options for xanthogranulomatous cholecystitis[J]. Med Princ Pract, 2013, 22(1): 18-23.
10.	Chun KA, Ha HK, Yu ES, et al. Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma[J]. Radiology, 1997, 203(1): 93-97.
11.	施勤, 周建胜, 张峭巍, 等.黄色肉芽肿性胆囊炎的CT表现[J].中华放射学杂志, 2006, 40(1): 86-88.
12.	Jetley S, Rana S, Khan RN, et al. Xanthogranulomatous cholecystitis-a diagnostic challenge[J]. J Indian Med Assoc, 2012, 110(11): 833-837.
13.	黄子星, 陈光文, 鲁昌立, 等.黄色肉芽肿性胆囊炎的MRI表现特点[J].中国临床医学影像杂志, 2010, 21(12): 856-859.
14.	Ghosh M, Sakhuja P, Agarwal AK. Xanthogranulomatous cholecystitis: a premalignant condition?[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(2): 179-184.
15.	Krishnani N, Dhingra S, Kapoor S, et al. Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases[J]. Acta Cytol, 2007, 51(1): 37-41.
16.	Zhuang PY, Zhu MJ, Wang JD, et al. Xanthogranulomatous cholecystitis: a clinicopathological study of its association with gallbladder carcinoma[J]. J Dig Dis, 2013, 14(1): 45-50.
17.	Ogura T, Kurisu Y, Masuda D, et al. A case of xanthogranulomatous cholecystitis diagnosed by EUS-FNA in which changes were observed on FDG-PET[J]. Nihon Shokakibyo Gakkai Zasshi, 2013, 110(9): 1640-1648.
18.	Hale MD, Roberts KJ, Hodson J, et al. Xanthogranulomatous cholecystitis: a European and global perspective[J]. HPB (Oxford), 2014, 16(5): 448-458.
19.	Wang M, Zhang T, Zang L, et al. Surgical treatment for xanthogranulomatous cholecystitis: a report of 74 cases[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 231-233.
20.	Karakaya K, Taşçilar O, Karadeniz Cakmak G, et al. Surgical challenge in cholecystectomy: xanthogranulomatous cholecystitis[J]. Turk J Gastroenterol, 2007, 18(2): 131-132.
21.	张有钫, 王小明.黄色肉芽肿性胆囊炎2例报告[J].中国普外基础与临床杂志, 2000, 7(3): 166-166.
22.	Yang T, Zhang BH, Zhang J, et al. Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(5): 504-508.
23.	Kim JH, Jeong IH, Yoo BM, et al. Is xanthogranulomatous cholecystitis the most difficult for laparoscopic cholecystectomy?[J]. Hepatogastroenterology, 2009, 56(91-92): 597-601.

1. McCoy JJ Jr, Vila R, Petrossian G, et al. Xanthogranulomatous cholecystitis. Report of two cases[J]. J S C Med Assoc, 1976, 72(3): 78-79.
2. Guzmán-Valdivia G. Xanthogranulomatous cholecystitis in laparoscopic surgery[J]. J Gastrointest Surg, 2005, 9(4): 494-497.
3. Goodman ZD, Ishak KG. Xanthogranulomatous cholecystitis[J]. Am J Surg Pathol, 1981, 5(7): 653-659.
4. 张旭日, 崔乃强, 赵二鹏, 等. 45例黄色肉芽肿性胆囊炎临床治疗分析[J].中国中西医结合外科杂志, 2011, 17(4): 352-354.
5. Han SH, Chen Yl. Diagnosis and treatment of xanthogranulomatous cholecystitis: a report of 39 cases[J]. Cell Biochem Biophys, 2012, 64(2): 131-135.
6. Zhao F, lu PX, Yan SX, et al. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases[J]. Eur J Radiol, 2013, 82(9): 1391-1397.
7. Uchiyama K, Ozawa S, Ueno M, et al. Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma[J]. J Hepatobiliary Pancreat Surg, 2009, 16(3): 333-338.
8. Jain S, Saluja SS, Sharma AK, et al. Xanthogranulomatous cholecystitis: catching the culprit-clinical and imaging analysis[J]. Dig Surg, 2012, 29(3): 187-193.
9. Cui Y, Zhang H, Zhao E, et al. Differential diagnosis and treatment options for xanthogranulomatous cholecystitis[J]. Med Princ Pract, 2013, 22(1): 18-23.
10. Chun KA, Ha HK, Yu ES, et al. Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma[J]. Radiology, 1997, 203(1): 93-97.
11. 施勤, 周建胜, 张峭巍, 等.黄色肉芽肿性胆囊炎的CT表现[J].中华放射学杂志, 2006, 40(1): 86-88.
12. Jetley S, Rana S, Khan RN, et al. Xanthogranulomatous cholecystitis-a diagnostic challenge[J]. J Indian Med Assoc, 2012, 110(11): 833-837.
13. 黄子星, 陈光文, 鲁昌立, 等.黄色肉芽肿性胆囊炎的MRI表现特点[J].中国临床医学影像杂志, 2010, 21(12): 856-859.
14. Ghosh M, Sakhuja P, Agarwal AK. Xanthogranulomatous cholecystitis: a premalignant condition?[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(2): 179-184.
15. Krishnani N, Dhingra S, Kapoor S, et al. Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases[J]. Acta Cytol, 2007, 51(1): 37-41.
16. Zhuang PY, Zhu MJ, Wang JD, et al. Xanthogranulomatous cholecystitis: a clinicopathological study of its association with gallbladder carcinoma[J]. J Dig Dis, 2013, 14(1): 45-50.
17. Ogura T, Kurisu Y, Masuda D, et al. A case of xanthogranulomatous cholecystitis diagnosed by EUS-FNA in which changes were observed on FDG-PET[J]. Nihon Shokakibyo Gakkai Zasshi, 2013, 110(9): 1640-1648.
18. Hale MD, Roberts KJ, Hodson J, et al. Xanthogranulomatous cholecystitis: a European and global perspective[J]. HPB (Oxford), 2014, 16(5): 448-458.
19. Wang M, Zhang T, Zang L, et al. Surgical treatment for xanthogranulomatous cholecystitis: a report of 74 cases[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 231-233.
20. Karakaya K, Taşçilar O, Karadeniz Cakmak G, et al. Surgical challenge in cholecystectomy: xanthogranulomatous cholecystitis[J]. Turk J Gastroenterol, 2007, 18(2): 131-132.
21. 张有钫, 王小明.黄色肉芽肿性胆囊炎2例报告[J].中国普外基础与临床杂志, 2000, 7(3): 166-166.
22. Yang T, Zhang BH, Zhang J, et al. Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(5): 504-508.
23. Kim JH, Jeong IH, Yoo BM, et al. Is xanthogranulomatous cholecystitis the most difficult for laparoscopic cholecystectomy?[J]. Hepatogastroenterology, 2009, 56(91-92): 597-601.

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Analysis of Diagnosis and Treatment of Xanthogranulomatous Cholecystitis in 48 Cases

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