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.