Tarzamni Mohammad Kazem, Aminzadeh Ghavifekr Homa, Zeynalkhani Hadise, Shirmohamadi Masoud, Eghbali Elham, Jafarizadeh Ali, Ghareghoran Seyed Siavash, Hashemizadeh Seyedeh Elnaz, Falahatian Masih
Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.
Radiol Case Rep. 2023 Jul 27;18(10):3513-3521. doi: 10.1016/j.radcr.2023.07.024. eCollection 2023 Oct.
Chronic gallbladder disease due to xanthogranulomatous cholecystitis is uncommon, and its symptoms are generally vague. While there is no firm evidence to link xanthogranulomatous cholecystitis to primary sclerosing cholangitis or ulcerative colitis. The patient is a 41-year-old male with a history of ulcerative colitis, primary sclerosing cholangitis, and biliary stenting who complained of symptoms of anorexia, jaundice, and pruritus. In the initial ultrasound exam, there was evidence of intrahepatic and extra-hepatic bile duct dilation along with a significant and mass-like circumferential thickening of the gallbladder wall. Magnetic resonance cholangiopancreatography was performed for further evaluation, which indicated increased gallbladder wall thickness, containing multiple T2 hyper-signal nodules while the mucosal layer was intact. There was also a filling defect in the common bile duct's distal portion. These findings matched a xanthogranulomatous cholecystitis diagnosis and a possibly malignant lesion in the distal of the common bile duct. The patient ultimately had a cholecystectomy, and pathology findings confirmed the diagnosis of xanthogranulomatous cholecystitis. Biopsy specimens obtained from the distal of the common bile duct lesion were microscopically identified as intramucosal adenocarcinoma. In patients with a history of primary sclerosing cholangitis who present with nonspecific symptoms suggesting chronic gallbladder disease and radiologic evidence of circumferential gallbladder wall thickening containing intramural nodules and intact mucosa, xanthogranulomatous cholecystitis should be kept in mind.
由黄色肉芽肿性胆囊炎引起的慢性胆囊疾病并不常见，其症状通常不明确。虽然没有确凿证据将黄色肉芽肿性胆囊炎与原发性硬化性胆管炎或溃疡性结肠炎联系起来。该患者是一名41岁男性，有溃疡性结肠炎、原发性硬化性胆管炎和胆道支架置入史，主诉有厌食、黄疸和瘙痒症状。在初次超声检查中，有肝内和肝外胆管扩张的证据，同时胆囊壁有明显的、肿块样的环形增厚。进行了磁共振胰胆管造影以进一步评估，结果显示胆囊壁增厚，包含多个T2高信号结节，而粘膜层完整。胆总管远端也有充盈缺损。这些发现符合黄色肉芽肿性胆囊炎的诊断以及胆总管远端可能存在恶性病变。患者最终接受了胆囊切除术，病理结果证实了黄色肉芽肿性胆囊炎的诊断。从胆总管病变远端获取的活检标本在显微镜下被鉴定为黏膜内腺癌。对于有原发性硬化性胆管炎病史且出现提示慢性胆囊疾病的非特异性症状以及有胆囊壁环形增厚伴壁内结节且黏膜完整的影像学证据的患者，应考虑黄色肉芽肿性胆囊炎。
