Xanthogranulomatous cholecystitis


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.