Nacif LS, Hessheimer AJ, Rodríguez Gómez S, Montironi C, Fondevila C. Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma. World J Gastroenterol 2017; 23(48): 8671-8678 [PMID: 29358875 DOI: 10.3748/wjg.v23.i48.8671]
Corresponding Author of This Article
Constantino Fondevila, MD, PhD, Associate Professor of Surgery, Hepatobiliary Surgery and Liver Transplant, Hospital Clínic, University of Barcelona, C/ Villarroel 170, Barcelona 08036, Spain. cfonde@clinic.ub.es
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Lucas Souto Nacif, Amelia Judith Hessheimer, Constantino Fondevila, Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDM), Hospital Clínic, Barcelona 08036, Spain
Lucas Souto Nacif, Amelia Judith Hessheimer, Constantino Fondevila, CIBERehd, IDIBAPS, University of Barcelona, Barcelona 08036, Spain
Sonia Rodríguez Gómez, Department of Radiology, Hospital Clínic, Barcelona 08036, Spain
Carla Montironi, Department of Pathology, Hospital Clínic, Barcelona 08036, Spain
Author contributions: Nacif LS and Hessheimer AJ contributed equally to this work; Nacif LS and Fondevila C designed the work; Nacif LS, Hessheimer AJ, Rodríguez Gómez S and Montironi C acquired and analyzed the data; Nacif LS and Hessheimer AJ wrote the manuscript; Rodríguez Gómez S, Montironi C and Fondevila C provided critical appraisal of the manuscript.
Supported by Nacif LS was supported by an International Travel Scholar Award from the International Liver Transplantation Society (ILTS).
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Constantino Fondevila, MD, PhD, Associate Professor of Surgery, Hepatobiliary Surgery and Liver Transplant, Hospital Clínic, University of Barcelona, C/ Villarroel 170, Barcelona 08036, Spain. cfonde@clinic.ub.es
Telephone: +34-93-2275718 Fax: +34-93-2275589
Received: September 13, 2017 Peer-review started: September 13, 2017 First decision: October 10, 2017 Revised: October 13, 2017 Accepted: November 21, 2017 Article in press: November 21, 2017 Published online: December 28, 2017 Processing time: 105 Days and 3.2 Hours
Abstract
Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis. The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas. Three patients presented mass lesions that infiltrated the hepatic hilum, provoked biliary dilatation and jaundice, and were indicative of malignancy. Surgical excision was performed following oncological principles and included extirpation of the gallbladder, extrahepatic bile duct, and hilar lymph nodes, as well as partial hepatectomy. Postoperative morbidity was minimal. Surgical pathology demonstrated XGC and absence of malignancy in all three cases. All three patients are alive and well after years of follow-up. XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology. In such cases, the best option may be radical resection following oncological principles performed by expert surgeons, in order that postoperative complications may be minimized if not avoided altogether.
Core tip: Though it is a benign disease process, xanthogranulomatous cholecystitis may have an aggressive presentation suggestive of a carcinoma of the gallbladder or biliary tract. In such cases, the best option may be surgical resection performed by expert surgeons following oncological principles, in order to cure affected patients without provoking postoperative morbidity.
