Xanthogranulomatous Cholecystitis Mimicking as Gallbladder Carcinoma：A Caution for Hepatobiliary Surgeon

Abstract

Background: Xanthogranulomatous Cholecystitis (XGC) is a destructive inflammatory process of the gall bladder which can rarely extend into neighboring structures mimicking advanced carcinoma of the gall bladder. To the best of our knowledge six such cases have been reported in medical literature in which Xanthogranulomatous cholecystitis had lead to involvement of surrounding structures. Preoperative diagnosis of such a lesion remains difficult and most of such cases are diagnosed postoperatively following resectional surgery. 

Case Presentation: A 40 years old lady was admitted with the clinical picture of cholecystitis and gastric outlet obstruction. Ultrasonography showed gall stones with pericholecystic collection communicating with GB lumen. CT scan showed a mass arising from gallbladder with pericholecystic fluid with gross distension of the stomach. LFTs, CEA and CA 19-9 levels were within normal limits. Endoscopy of the stomach showed an apparently non-epithelial rounded mass projecting into gastric lumen causing partial obstruction of the gastric outlet. On exploration, a firm mass involving gallbladder and stomach was identified for which en-bloc extended cholecystectomy and Billroth-II gastrectomy was performed. Histopathology of the specimen revealed XGC with secondary involvement of pylorus of the stomach.

Conclusion: Given the rarer preoperative diagnosis of XGC, which morphologically and radiologically mimics carcinoma, such cases should be managed aggressively. A brief literature review has also been discussed.