XANTHOGRANULOMATOUS CHOLECYSTITIS - A CLINICOPATHOLOGICAL STUDY OF 20CASES AND REVIEW OF THE LITERATURE

Xanthogranulomatous cholecystitis (XGC) is a focal or diffuse destruct ive inflammatory process of the gall bladder, characterized macroscopi cally by yellowish tumour-like masses in the wall of the gall bladder. Microscopically, it is characterized in the early stages by a large n umber of foamy histiocytes and acute inflammatory cells. Later stages demonstrate increasing fibrosis. The gall bladder from 20 of 352 conse cutive patients subjected to cholecystectomy showed XGC. Gall stones w ere found in the gall bladder of all 20 patients and in the ductus cho ledochus in 3 cases. Perforation of the gall bladder was observed at o peration in six cases; in one case there was also a fistula to the col on. A perivesical abscess was found in five other cases. Adhesions to the surrounding structures were seen in a total of 16 cases. Pathogene tically, XGC is probably due to an interplay between obstruction of th e gall flow, infection with subsequent inflammation, and leakage of ga ll fluid to the tissue, where histiocytes accumulate and phagocytize t he bile pigment, haemosiderin and cholesterol, resulting in the format ion of xanthoma cells. The correct diagnosis of XGC is important for s everal reasons, first and foremost due to the high frequency of compli cations, but not least because the condition may give rise peroperativ ely to the suspicion of malignancy. The new laparoscopic method for ch olecystectomies further stresses the necessity of correct preoperative diagnosis of complicating disease.