Ishii Takamichi, Hatano Etsuro, Yasuchika Kentaro, Taura Kojiro, Shirahase Hiroyuki, Haga Hironori, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe 651-2273, Japan.
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Int J Surg Case Rep. 2014;5(3):138-41. doi: 10.1016/j.ijscr.2014.01.011. Epub 2014 Jan 24.
Xanthogranulomatous cholecystitis (XGC) is a variant of chronic cholecystitis. XGC remains difficult to distinguish from gallbladder cancer radiologically and macroscopically.
A 63-year-old female was referred to our hospital because of a gallbladder tumor. Abdominal CT and MRI revealed a thickened gallbladder that had an obscure border with the transverse colon. FDG-PET showed a high uptake of FDG in the gallbladder. Therefore, under the preoperative diagnosis of an advanced gallbladder cancer with invasion to the transverse colon, a laparotomy was performed. Because adenocarcinoma was suspected based on the intraoperative peritoneal washing cytology (IPWC), cholecystectomy and partial transverse colectomy were performed instead of radial surgery. However, the case was proven to be XGC with no malignant cells after the operation.
In patients with gallbladder cancer who underwent surgery in our institute from 2000 to 2009, the prognosis after the operation of patients with only positive IPWC tended to be better than that of patients with definitive peritoneal disseminated nodules. It is true that in some cases, it is difficult to differentiate XGC from gallbladder carcinoma pre- and intra-operatively.
Surgical procedures should be selected based on the facts that there are long-term survivors with gallbladder cancer diagnosed with positive IPWC, and that some patients with XGC are initially diagnosed to have carcinoma by IPWC, as was seen in our case.
黄色肉芽肿性胆囊炎（XGC）是慢性胆囊炎的一种变体。XGC在影像学和宏观层面上仍难以与胆囊癌区分开来。
一名63岁女性因胆囊肿瘤被转诊至我院。腹部CT和MRI显示胆囊增厚，与横结肠边界不清。FDG-PET显示胆囊内FDG摄取高。因此，在术前诊断为晚期胆囊癌侵犯横结肠的情况下，进行了剖腹手术。由于术中腹腔冲洗细胞学检查（IPWC）怀疑为腺癌，故行胆囊切除术和部分横结肠切除术，而非根治性手术。然而，术后病例被证实为XGC，未见恶性细胞。
在2000年至2009年期间在我院接受手术的胆囊癌患者中，仅IPWC阳性的患者术后预后往往优于有明确腹膜播散结节的患者。确实，在某些情况下，术前和术中很难将XGC与胆囊癌区分开来。
手术方式的选择应基于以下事实，即有IPWC阳性诊断的胆囊癌患者存在长期存活者，且部分XGC患者最初通过IPWC被诊断为癌症，如我们的病例所示。
