Description, Causes and Risk Factors:
Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in areas of destructive inflammation. The macroscopic appearance generally mimics a gallbladder carcinoma.
The pathogenesis of XGC is obscure, although it has been stated, that acute inflammation and obstruction with stasis, is an important etiologic factor. Its pathogenesis consists of an interplay between obstruction to bile flow with infection and subsequent inflammation associated with leakage of bile to tissues where histiocytes accumulate and phagocytose the bile pigment, hemosiderin and cholesterol, resulting in formation of xanthoma cells.
Another possible cause is chronic infection and gallstones with bile stasis. Some authors have attributed the process to delayed type hypersensitivity reaction. Immunohistochemical studies have demonstrated a closer correlation with bacterial infection in the sub-acute form than in the chronic one.
Normally it presents at 45-60 years of age group with equal incidence in both the sexes with more malignant potential in females.
Xanthogranulomatous cholecystitis has unusual presentation. It presents mainly with complications such as empyema, pericholecystic abscess, perforation and cholecystoduodenal fistula. Other symptoms such as the recurrent right upper abdominal pain, obstructive jaundice, fever, acute cholecystitis attack, right upper quadrant mass may also present.
The pre- or intraoperative differential diagnosis of XGC from other gallbladderdiseases remains a challenge in medicalpractice. The presence of firm adhesionsof the gallbladder to neighboring organsand tissues, thickened gallbladder wall,together with gallstone in a patient withchronic disease, is highly suggestive ofXGC.
The common imaging techniques, for example ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), are able to detect abnormalities of the gallbladder, but they are not always able to differentiate XGC from GB (gallbladder) cancer, and the final diagnosis is usually made by histological examination of the resected specimen.
On? histologic? examination? too,? diagnostic? difficulty can? arise? due? to? presence? of? deep? Rokitansky-Aschoff sinuses and? inflammatory? atypia? in? the? epithelium.? In such? cases,? combined? immunohistochemical? staining with? p53,? PCNA? and? beta-catenin? can? be? of? some? help. In patient with no nuclear beta-catenin staining, or low p53 positivity and low PCNA (proliferating cell nuclear antigen) index score may help clear the ambiguity in diagnosis XGC. This can prevent a patient from excessive surgery.
The treatment of choice would be surgery. An accurate preoperative diagnosis with a careful surgical planning is very important in the management of XGC. The severe inflammatory process with dense adhesions and edematous tissues distort the anatomy. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
It is well known that our overall health and wellbeing are totally dependable on what we eat. That is why a healthy diet plays a significant role in keeping the body healthy. Day after day, scientists all over the world make new discoveries proving that certain...
A new study finds that brain volumes of people who regularly eat vegetables, fruit, and fish are on average 2ml greater than brain volumes of those who often drink sugary beverages. A brain volume reduction of 3.6ml equals to one year of aging. For the study, the...
Quiz about this article
0 of 2 questions completed
Please answer on few questions to make our service more useful
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
0 of 2 questions answered correctly
Time has elapsed
You have reached 0 of 0 points, (0)
Question 1 of 2
Was this article useful for you?Correct
Thanks for your feedback!Incorrect
Thanks for your feedback!
Question 2 of 2
What else information about this disease you want to know ?Correct
Thanks for feedback!Incorrect
Thanks for feedback!
Good weather is the best reason to do outdoor sports, which will help not only lose weight, but also will strengthen health. Bicycle The sun dries out the local paths, so you can safely sit on your favorite bike and confidently twist the pedals, where the eyes look....read more
First aid for injuries consists of simple rules that need to be clearly implemented. If this is a closed injury, you need to immobilize the injured limb, otherwise the person may lose consciousness from a painful shock. If you need to get to the emergency room...read more
Many people spontaneously decide starting to do sport, while others weigh all the pros and cons for a log time. But almost all of them make the same mistakes, listening to the advice of non experts. There are 10 anti-tips for those who want to do plan to do some sport...read more