Department of General Surgery, Department of Radiology, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2012 Jan;125(1):109-13.
Patients with xanthogranulomatous cholecystitis sometimes exhibit imaging and intraoperative findings that are similar to those of advanced gallbladder cancer, thus these patients are easily misdiagnosed. The present study aimed to investigate the characteristics of xanthogranulomatous cholecystitis masquerading as gallbladder cancer that could potentially aid in the correct diagnosis of this condition.
The clinical, serological, radiological and operative features of twelve patients with obviously wall-thickening or mass-forming xanthogranulomatous cholecystitis were retrospectively analyzed. Additionally, the patient preoperative features were compared to those of 36 patients with advanced gallbladder cancers.
Twelve patients with xanthogranulomatous cholecystitis exhibited one to three episodes of acute cholecystitis within 0.5 to 7 months prior to admission to the hospital. Five of these patients exhibited concomitant choledocholithiasis, whereas no concomitant choledocholithiasis was identified in patients with advanced gallbladder cancer. The incidence of abdominal pain (χ(2) = 6.588, P = 0.010), acute cholecystitis (χ(2) = 29.176, P = 0.000), acute cholangitis (χ(2) = 6.349, P = 0.012), choledocholithiasis (χ(2) = 16.744, P = 0.000), carcinoembryonic antigen test (P = 0.007), CA125 (P = 0.001), and diffuse gallbladder wall thickening (χ(2) = 6.031, P = 0.014), continued mucosal line (χ(2) = 15.745, P = 0.000), homogeneous enhancement of mucosal line (χ(2) = 19.947, P = 0.000), submucosal hypoattenuated nodules or band (χ(2) = 18.607, P = 0.000) in computed tomography demonstrated statistically significant differences between cases of xanthogranulomatous cholecystitis and gallbladder cancer. Furthermore, all the twelve patients with xanthogranulomatous cholecystitis exhibited at least one positive computed tomography imaging feature aside from past acute cholecystitis episode, and no patient with advanced gallbladder cancer simultaneously exhibited past acute cholecystitis episode and at least one positive computed tomography imaging feature.
The accurate preoperative diagnosis of xanthogranulomatous cholecystitis includes an integrated review of past acute cholecystitis episode, choledocholithiasis, and positive computed tomography imaging features. Besides, we present an algorithm for intraoperative diagnosis.
黄色肉芽肿性胆囊炎患者的影像学和术中表现有时类似于晚期胆囊癌，因此容易误诊。本研究旨在探讨可能有助于正确诊断该病的黄色肉芽肿性胆囊炎伪装成胆囊癌的特征。
回顾性分析 12 例明显壁增厚或肿块形成的黄色肉芽肿性胆囊炎患者的临床、血清学、影像学和手术特征。此外，将术前特征与 36 例晚期胆囊癌患者进行比较。
12 例黄色肉芽肿性胆囊炎患者在入院前 0.5 至 7 个月内有 1 至 3 次急性胆囊炎发作。其中 5 例合并胆总管结石，而晚期胆囊癌患者无合并胆总管结石。腹痛发生率（χ²=6.588，P=0.010）、急性胆囊炎（χ²=29.176，P=0.000）、急性胆管炎（χ²=6.349，P=0.012）、胆总管结石（χ²=16.744，P=0.000）、癌胚抗原试验（P=0.007）、CA125（P=0.001）、弥漫性胆囊壁增厚（χ²=6.031，P=0.014）、连续黏膜线（χ²=15.745，P=0.000）、黏膜线均匀强化（χ²=19.947，P=0.000）、黏膜下低衰减小结节或条带（χ²=18.607，P=0.000）在 CT 上显示黄色肉芽肿性胆囊炎和胆囊癌之间存在统计学差异。此外，除既往急性胆囊炎发作外，所有 12 例黄色肉芽肿性胆囊炎患者均至少有一个阳性 CT 影像学特征，而晚期胆囊癌患者均无既往急性胆囊炎发作且至少有一个阳性 CT 影像学特征。
黄色肉芽肿性胆囊炎的准确术前诊断包括综合回顾既往急性胆囊炎发作、胆总管结石和阳性 CT 影像学特征。此外，我们提出了一种术中诊断的算法。
