SEVEN CASES OF XANTHOGRANULOMATOUS CHOLECYSTITIS

Seven cases diagnosed pathologically as xanthogranulomatous cholecystitis (XGC) were reviewed. The incidence of XGC was 2.4% among 288 patients whose gallbladders were surgically removed in Kushiro Rosai Hospital over the past 3 years. The average age of the 7 patients reviewed (1 male and 6 females) was 58 years, ranging from 35 to 77. Clinically, 6 (85.7%) of the 7 patients had symptoms such as epigastric pain (6), fever (4), icterus (3) and septic shock (1). The thickness of the gallbladder wall and the presence of gallstones were determined by echography in all cases. However, the gallbladder was visualized by cholangiography (DIC or ERC) in only 4 cases (57.0%). By computed tomography (CT), the thickened wall of the gallbladder was recognized as being a low density area (LDA) in all cases, and LDA of the wall was enhanced on the enhancement CT in one case. Preoperative diagnosis was cholelithiasis except in one case where gallbladder cancer was suspected. During the operation, 3 patients were found to have severe inflammation and adhesion to the liver bed. There was one patient in whom XGC was combined with gallbladder cancer was not suspected prior to the operation. Rediologically, the differential diagnosis of gallbladder cancer and XGC was difficult in these cases. There are probably some cases of XGC found only after surgery. Therefore, when examining the gallbladder it is important to consider the existence of XGC associated with cholecystlithiasis.