Spinelli Antonino, Schumacher Guido, Pascher Andreas, Lopez-Hanninen Enrique, Al-Abadi Hussain, Benckert Christoph, Sauer Igor M, Pratschke Johann, Neumann Ulf P, Jonas Sven, Langrehr Jan M, Neuhaus Peter
Department of Ge-neral, Visceral and Transplantation Surgery, Charitè-Universitatsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
World J Gastroenterol. 2006 Apr 14;12(14):2293-6. doi: 10.3748/wjg.v12.i14.2293.
Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy, right hemicolectomy, and a partial duodenal resection. Pathological examination unexpectedly revealed an XGC. Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.
黄色肉芽肿性胆囊炎（XGC）是一种胆囊的破坏性炎症性疾病，很少累及邻近器官，且酷似晚期胆囊癌。通常只有在病理检查后才能确诊。一名46岁女性因怀疑胆囊癌累及肝门、右肝叶、右结肠曲和十二指肠而被转诊至我院。经内镜逆行胆管造影（ERC）获取的刷检细胞学检查显示高级别发育异常。该患者接受了肿物整块切除，包括右叶切除术、右半结肠切除术和部分十二指肠切除术。病理检查意外发现为XGC。迄今为止，仅报道了6例因XGC直接累及邻近器官而进行扩大手术切除的病例。在这些病例中，鉴于XGC可能与癌并存，即使经过细胞学检查和术中冰冻切片检查，也不能排除恶性肿瘤的可能。总之，一方面由于胆囊癌预后较差，另一方面由于周围器官高度侵袭性炎症浸润可能导致并发症，在未得到其他证实之前，这些病例似乎应按恶性肿瘤治疗。临床医生应将XGC纳入肝门肿物可能的鉴别诊断之中。
