Rammohan Ashwin, Cherukuri Sathya D, Sathyanesan Jeswanth, Palaniappan Ravichandran, Govindan Manoharan
The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India.
Gastroenterol Res Pract. 2014;2014:253645. doi: 10.1155/2014/253645. Epub 2014 Oct 27.
Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.
背景。黄色肉芽肿性胆囊炎（XGC）常被误诊为胆囊癌（GBC）。我们旨在确定可能有助于准确诊断伪装成GBC的XGC的术前特征。方法。对2008年1月至2012年12月期间术前诊断为GBC并接受手术的患者进行分析，以确定有助于术前诊断XGC的临床和放射学特征。结果。在77例行根治性胆囊切除术的患者中，最终组织病理学报告为XGC的有16例（A组），而GBC的有60例（B组）。A组腹痛、胆石症、胆总管结石和急性胆囊炎的发生率显著更高，而B组厌食和体重减轻的发生率更高。在CT上，胆囊壁弥漫性增厚、黏膜线持续强化和黏膜下低密度结节是A组的显著表现。回顾性CT结果显示，68.7%的病例至少有这些表现之一。结论。区分XGC和GBC很困难，明确诊断仍需组织病理学检查。准确的术前诊断需要综合评估临床和特征性放射学特征，这些特征的存在可能有助于避免在某些病例中进行根治性切除和避免不必要的发病率。
