Xanthogranulomatous Cholecystitis Pseudotumoral: About A Case (Article)

Xanthogranulomatous cholecystitis is a rare form of chronic cholecystitis that its clinical presentation, radiological and even can simulate a macroscopic cancer of the gallbladder. the etiology remains unclear, the most plausible hypothesis is a chronic infection of the gallbladder with default discharge of bile. We report a case of xanthogranulomatous cholecystitis operated with the diagnosis of suspected cancer of the gallbladder and whose diagnosis was established by histological examination.

OBSERVATION:
This is the patient KN 63ans old admitted through the emergency room for care more defense dune pain right hypochondrium with vomiting and fever 38.3 ° C and leukocytosis with biology.
An ultrasound abdominal which objective was achieved: a calculous gallbladder wall thickening seat cubicle hypoechogene The patient was admitted for treatment acute calculous cholecystitis dune.
After a treatment based on antibiotics and analgesics was performed abdominal scanner  which aim thickened gallbladder lithiasis with invasion of segment4 with the presence of several nodes pedicle; gallbladder suspicious?

The patient was operated on eight days after admission for acute gallstone cholecystitis (gallbladder suspect) n extemporaneous examination was not available, anapath final specimen is returned for fibrous reaction with an inflammatory granuloma multiforme rich histiocytic cells and absence of any sign of malignancy: This aspect was in favor of xanthogranulomatous cholecystitis

DISCUSSION:
Xanthogranulomatous cholecystitis is a rare form of chronic cholecystitis can simulate gallbladder cancer biliary both clinically, radiologically as macroscopically. While the etiology remains unclear, the most plausible is a chronic infection the absence of gallbladder with bile evacuation.

CONCLUSION:
Despite advances in medical imaging, the diagnosis of xanthogranulomatous cholecystitis, in its pseudo-tumor remains difficult preoperatively. The differential diagnosis especially with gallbladder cancer, which can lead to a disproportionate surgery

bibliography:

  1. McCoy JJ, Vila R, Petrossian G, et al (1976) Xanthogranulomatous cholecystitis. JSC Med Assoc 72:781–9
  2. Goodman ZD, Ishak KG (1981) Xanthogranulomatous cholecystitis. Am J Surg Pathol 5:653–6
  3. Ros PR, Goodman ZD (1997) Xanthogranulomatous cholecystitis versus gallbladder carcinoma. Radiology 203:10–2
  4. Guzman-Valdivia G (2004) Xanthogranulomatous
Posted by: zatir soufiane, general surgeon, militery university hospital oran, Algeria (09-Nov-2012)
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