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Gallbladder Pathology Online

Pathology of Xanthogranulomatous Cholecystitis

Dr Sampurna Roy MD   


Xanthogranulomatous cholecystitis is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma.

The lesions appear to result from ruptured Rokitansky-Aschoff sinuses with intramural extravasation of bile and subsequent xanthogranulomatous reaction.

It has been suggested that xanthogranulomatous cholecystitis can be divided into two forms: subacute and chronic, and the subacute form is closely related to bacterial infection.

The diagnosis is usually possible only after pathological examination. 

Clinically, xanthogranulomatous cholecystitis often  presents as a severe chronic cholecystitis associated with abdominal pain, fever, and leukocytosis.

Gallstones are present in most cases.

This unusual entity is characterized morphologically by a broad spectrum of xanthogranulomatous changes seen from a small limited focus within yellow nodule in the gallbladder wall, to diffuse involvement of the entire gallbladder with extension of the fibrosis into surrounding tissues. 

Xanthogranulomatous cholecystitis may form a tumour-like mass in inflamed gallbladders.

Grossly the lesions are usually soft, yellow to brown, and measure up to 2.5 cm. 


Microscopically, there are varying amounts of  inflammation, xanthoma-like foam cells, and scarring.

Lipid is ingested by macrophages, which have the appearance of xanthoma cells and giant cells of foreign- body and Touton type.

This is usually seen in association with dense fibrous tissue.

At operation, there are adhesions to surrounding tissues, and sometimes a mass is found, mimicking tumour of the gallbladder.

Visit:  Acute cholecystitis ; Acalculous cholecystitis ;Emphysematous cholecystitis ; Eosinophilic Cholescystitis ; Necrobiotic Xanthogranuloma of the the skin  


Further reading:

Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature.World J Gastroenterol. 2006 Apr 14;12(14):2293-6.

Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma.Trop Gastroenterol. 2005 Jan-Mar;26(1):31-3.

Epidemiology of xanthogranulomatous cholecystitis. Cir Cir. 2005 Jan-Feb;73(1):19-23.

Xanthogranulomatous cholecystitis: retrospective analysis of 6 cases.Rev Gastroenterol Peru. 2005 Jan-Mar;25(1):93-100.

Xanthogranulomatous cholecystitis in laparoscopic surgery.J Gastrointest Surg. 2005 Apr;9(4):494-7

Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis.: J Am Coll Surg. 2004 Aug;199(2):204-10.

Xanthogranulomatous cholecystitis mimicking stage IV gallbladder cancer.Hepatogastroenterology. 2003 Sep-Oct;50(53):1255-8.

Xanthogranulomatous cholecystitis. Retrospective analysis of 12 cases.Acta Chir Belg. 2003 Jun;103(3):297-9.

Genetic analysis of xanthogranulomatous cholecystitis: precancerous lesion of gallbladder cancer? Hepatogastroenterology. 2002 ;49(46):935-7.

Xanthogranulomatous cholecystitis. Histopathological study and classification.Pathol Res Pract. 1990 Jun;186(3):383-90.

Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases.Hepatobiliary Pancreat Dis Int. 2007 Oct;6(5):504-8.

Involvement of Escherichia coli in pathogenesis of xanthogranulomatous cholecystitis with scavenger receptor class A and CXCL16-CXCR6 interaction.Pathol Int. 2007 Oct;57(10):652-63.

Perfidious gallbladders - a diagnostic dilemma with xanthogranulomatous cholecystitis.Ann R Coll Surg Engl. 2007 Mar;89(2):168-72.

Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases.Acta Cytol. 2007 Jan-Feb;51(1):37-41.

Xanthogranulomatous cholecystitis mimicking gallbladder cancer: report of a case.Kurume Med J. 2001;48(4):321-4.

Infectious etiology of xanthogranulomatous cholecystitis: immunohistochemical identification of bacterial antigens in the xanthogranulomatous lesions. Pathol Int. 1999;49(10):849-52.

Xanthogranulomatous cholecystis. Cell composition and a possible pathogenetic role of cell-mediated immunity.Pathol Res Pract. 1995 Nov;191(11):1078-86.

Preoperative diagnosis of xanthogranulomatous cholecystitis.J Radiol. 1995 Jul;76(7):445-8.

Xanthogranulomatous cholecystitis. A clinicopathological study of 20 cases and review of the literature.APMIS. 1993 Nov;101(11):869-75.

Clinico-pathological study of xanthogranulomatous cholecystitis.Nippon Geka Gakkai Zasshi. 1990 Aug;91(8):1001-10.









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