Xanthogranulomatous cholecystitis: Radiologic findings with histologic correlation that focuses on intramural nodules

OBJECTIVE, The purpose of this study was to histologically classify intramu ral nodules associated with xanthogranulomatous cholecystitis and to evalua te the radiologic findings for each type of nodule. MATERIALS AND METHODS. Pathologic slides and radiologic studies including 1 4 sonographic and 16 CT examinations in 19 patients (12 men, seven women; m ean age, 61 years) with xanthogranulomatous cholecystitis were reviewed. Ra diologic findings were correlated with the histologic type of intramural no dule, abscess, xanthogranuloma, or a combination of the two. The duration o f symptoms for each type of intramural nodule was also evaluated. RESULTS. Histologically, all patients had intramural nodules that were eith er abscesses (n = 11), xanthogranulomas (n = 5), or a combination of the tw o (n = 3), Radiologic studies revealed nodules in 10 patients (52.6%; four abscesses, four xanthogranulomas, and two combinations). For abscesses, the mean interval from onset of symptoms to surgery was 25 days; for xanthogra nulomas, 70 days (p = .0057). Abscesses were associated with more complicat ions of xanthogranulomatous cholecystitis. CONCLUSION. Intramural nodules in patients with xanthogranulomatous cholecy stitis were found to represent abscesses or xanthogranulomas at histology. Xanthogranulomas were more often revealed radiologically than were abscesse s. Abscesses caused more clinical complications. Because symptoms lasted lo nger for xanthogranulomas, we hypothesized that abscesses may become xantho granulomas.