Coexistence of xanthogranulomatous cholecystitis and gallbladder cancer - A case report

Abstract

Xanthogranulomatous cholecystitis is an uncommon condition difficult to differentiate preoperatively from gallbladder cancer. We report a rare case of xanthogranulomatous cholecystitis (XGC) combined with gallbladder cancer in a 69-year-old Japanese woman. Diagnostic imaging, including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) disclosed a thickened gallbladder wall with multiple cystic lesions in the fundus of the gallbladder. A papilary tumor was also seen in the body of the gallbladder. Endoscopic retrograde cholangiography showed cystic duct obstruction. Angiography displayed a hypervascular lesion in the gallbladder. Under a tentative diagnosis of XGC and/or gallbladder cancer, we conducted full-thickness cholecystectomy. Intraoperative frozen sectioning of the resected gallbladder revealed XGC in the fudus and a well-differentiated tubular adenocarcinoma confined to the proper muscular layer in the papillary lesion. Pigment stones existed in both gallbladder and common bled duct. Since the cancer was histologically free of XCG, the two were considered to have developed independently. US, CT, and MRI were useful in diagnosing XGC, but it was difficult to differentiate cancer from XGC preoperatively. Thus, in all cases in which XGC is initially diagnosed, the possible coexistence of carcinoma should be suspected and surgical procedure be carefully considered based on histological examination of intraoperative frozen sections.