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Gallbladder

Cholecystitis

Xanthogranulomatous cholecystitis


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 11 February 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● 1-2% of surgically excised gallbladders
● Usually women ages 60-70 years
● Due to rupture of Rokitansky-Aschoff sinuses with extravasation of bile, or ulceration of gallbladder mucosa
● Resembles carcinoma at surgery; often associated with extended surgical resections (Dig Surg 2012;29:187, Gut Liver 2010;4:518)
● Frozen sections may prevent extended resections (Cell Biochem Biophys 2012;64:131)
● Complications include perforation, abscess formation, fistulous tracts, extension to liver, colon or soft tissue
● Associated with malignancy

Case reports
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● 76 year old man with false positive PET scan (World J Gastroenterol 2009;15:3691)
● 80 year old woman with perforation presenting as biloma (Korean J Gastroenterol 2011;58:153)
● Two cases (Acta Gastroenterol Latinoam 2011;41:331)

Gross description
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● Yellow-brown, poor to well-demarcated foci of wall thickening with variable ulceration, simulates neoplasm

Gross images
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Diffuse wall thickening

Micro description
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● Foamy macrophages or macrophages with ceroid, bile or iron
● Also cholesterol clefts and multinucleated giant cells
● May be focal, nodular or diffuse
● May contain lymphocytes, plasma cells, foreign body giant cells and neutrophils

Micro images
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Foamy macrophages and chronic inflammatory cells

Differential diagnosis
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Carcinoma of gallbladder
Granulomatous cholecystitis
● Inflammatory myofibroblastic tumor
● Sarcoma

End of Gallbladder > Cholecystitis > Xanthogranulomatous cholecystitis


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