Gallbladder & extrahepatic bile ducts

Cholecystitis

Xanthogranulomatous cholecystitis



Last author update: 28 October 2021
Last staff update: 28 October 2021

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PubMed Search: Xanthogranulomatous cholecystitis gallbladder [TI] free full text [SB]

Soon Auck Hong, M.D., Ph.D.
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Cite this page: Elbendary A, Hong SA. Xanthogranulomatous cholecystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladderxanthogranulomatous.html. Accessed July 5th, 2022.
Definition / general
  • Unusual histologic variant of chronic cholecystitis
  • Infiltration of foamy histiocytes and fibrosis in the background of chronic active inflammation
Essential features
  • Xanthogranulomatous cholecystitis (XGC), in clinical and radiologic findings, can frequently mimic gallbladder cancer
  • Pathologic findings are quite characteristic with foamy histiocytes, fibrosis and chronic active inflammation; when XGC is confused with gallbladder cancer, frozen examination can be useful in excluding malignancy
Epidemiology
Pathophysiology
Etiology
  • Gallstones
Clinical features
  • Patients' symptoms manifest as acute cholecystitis
Diagnosis
  • XGC is usually diagnosed with histopathologic examination
  • Radiologic imaging, including computed tomography, ultrasonography and magnetic resonance imaging, can be helpful but are limited for diagnosis
Case reports
Treatment
  • Cholecystectomy
Gross description
  • Irregular thickening of the gallbladder wall with multiple yellow nodules
Microscopic (histologic) description
  • Round to spindled shaped, lipid laden macrophages, giant cells and proliferative fibrosis in the background of chronic active inflammation (lymphocytes, plasma cells, neutrophils and eosinophils)
  • Transmural inflammation, mural and extramural inflammatory nodule
  • Small foci of xanthomatous inflammation associated with chronic cholecystitis cannot be qualified as XGC
  • Reference: World J Radiol 2016;8:183
Microscopic (histologic) images

Contributed by Amira Elbendary, M.B.B.Ch., M.Sc. and Soon Auck Hong, M.D., Ph.D.
Transmural inflammation

Transmural inflammation

Foamy histiocytes

Foamy histiocytes

Positive stains
Negative stains
  • Cytokeratin may be needed to exclude carcinoma of the gallbladder
Sample pathology report
  • Gallbladder, cholecystectomy:
    • Xanthogranulomatous cholecystitis
Differential diagnosis
Board review style question #1
In a resected gallbladder, histopathologic examination showed sheets of histiocytes in the gallbladder. PAS staining demonstrated intracytoplasmic granules in histiocytes. What is the best diagnosis?

  1. Hemophagocytosis
  2. Malakoplakia
  3. Rosai-Dorfmann disease
  4. Signet ring cell carcinoma
  5. Xathogranulomatous cholecystitis
Board review style answer #1
B. Malakoplakia. Malakoplakia is rare but can occur in the gallbladder. The histologic findings are very similar to those of xanthogranulomatous cholecystitis; however, histiocytes in malakoplakia are typically positive for PAS, while those in xanthogranulomoatus cholecystitis are negative.

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Reference: Xanthogranulomatous cholecystitis
Board review style question #2

A 63 year old patient visited the hospital with upper quadrant abdominal pain. Gallbladder cancer was strongly suspected in preoperative computed tomography. After the operation, histologic examination showed the findings in the image above. What is the best diagnosis?

  1. Acute emphysematous cholecystitis
  2. IgG4 related cholecystitis
  3. Mycobacterial infection
  4. Signet ring cell carcinoma
  5. Xanthogranulomatous cholecystitis
Board review style answer #2
E. Xanthogranulomatous cholecystitis. Xanthogranulomatous cholecystitis is a rare variant of cholecystitis. It frequently mimics gallbladder malignancy according to radiologic examination. Histopathologic examination shows round to spindled shaped, lipid laden macrophages, giant cells and proliferative fibrosis in the background of chronic active inflammation (lymphocytes, plasma cells, neutrophils and eosinophils).

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Reference: Xanthogranulomatous cholecystitis
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