Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Case Series and Literature Review

Background Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, often misdiagnosed as gallbladder malignancy. The clinical and radiological features often mimic gallbladder carcinoma, and the association of this entity with carcinoma makes the treatment decision difficult. Methods An analysis of patients operated on between July 2017 and December 2018 with a preoperative diagnosis of gallbladder malignancy, which ultimately turned out to be XGC, was conducted, in an attempt to determine the clinical and radiological features which could facilitate the preoperative diagnosis of XGC. Results The study included 6 patients who underwent radical cholecystectomy with a preoperative diagnosis of gallbladder malignancy, which proved on histological examination to be XGC. All 6 patients presented with mild upper abdominal pain, discomfort, anorexia and weight loss. Three of them had been diagnosed with diabetes mellitus (DM) in the past. Contrast enhanced computed tomography (CECT) scan showed gallbladder wall thickening, liver infiltration and lymphadenopathy in all cases. The surgery performed was radical cholecystectomy alone in 3 cases, radical cholecystectomy with right hemicolectomy in 2, and radical cholecystectomy with right hemicolectomy along with a Whipple procedure in one case. The postoperative course was uneventful, only two patients developed superficial wound infection, with an average hospital stay of 8.1 days. Conclusion Differentiation of XGC from gallbladder carcinoma is difficult, and a definitive diagnosis necessitates histopathological examination. An accurate preoperative diagnosis requires an integrated review of the clinical and characteristic radiological features, the presence of which may help to avoid radical resection and avoidable morbidity in selected cases. Knowledge of the entity, a high degree of suspicion and involvement of an expert surgeon should provide the optimal management. An incorrect diagnosis may lead to inappropriate surgery - either over-treating it by performing a radical cholecystectomy for XGC or perfoming a simple laparoscopic cholecystectomy for a malignant lesion.