Xanthogranulomatous cholecystitis


Several months of right upper quadrant abdominal pain.

Patient Data

Age: 55 years
Gender: Female

The gallbladder wall is grossly thickened and has large low attenuation spaces within the wall which do not communicating with the gallbladder lumen. 

Calculus impacted in the gallbladder neck causing distension of the gallbladder lumen. 

Chronic pancreatitis with parenchyma and ductal stones and pancreatic ductal dilatation. 

Large pseudocyst in the pancreatic head. 

Case Discussion

It can be challenging to distinguish benign and malignant gallbladder pathology on imaging, and they may coincide. Here the imaging features are typical of xanthogranulomatous cholecystitis, with dilated hypo-enhancing spaces in the wall. The luminal mucosa is intact throughout. 

This is presumed to have occurred secondary to a chronically impacted stone in the neck, raising the intraluminal pressure, and leading to rupture of the Rokitansky-Aschoff sinuses into the wall. 

The patient went on to open cholecystectomy. The pathological specimen demonstrated the typical features of xanthogranulomatous cholecystitis within the wall: foamy lipid-laden macrophages, bile pigment and chronic inflammatory cells. 

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