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Xanthogranulomatous Cholecystitis Mimicking Nodular Invasive Gallbladder Cancer. A Case Report and a Review of Our Cases Involving Previous Three Cases.

  • FUJII Masahiko
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • MIYAKE Hidenori
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • SASAKI Katsuya
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • ANDO Tsutomu
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • MATSUMURA Toshinobu
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • TASHIRO Seiki
    First Department of Surgery, School of Medicine, The Universiry of Tokushima
  • YAGI Keiko
    Tezuka Hospital

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Other Title
  • 結節浸潤型胆嚢癌との鑑別が困難であった黄色肉芽腫性胆嚢炎の1例

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Abstract

A 74-year-old man was admitted to the hospital because of epigastric pain. Ultrasound revealed an elevated lesion and stones on the fundus of gallbladder. Laparoscopic cholecystectomy was scheduled and initiated, when gallbladder cancer was suspected by laparoscopic findings. So we decided to suspend the operation and a two-step approach was employed. Abdominal CT scan and magnetic resonance imaging revealed thickening of the gallbladder wall and an elevated lesion protruding to the lumen. With a diagnosis of nodular invasive gallbladder cancer, a cholecystectomy, segmentectomies for S4a and S5, a resection of extrahepatic bile duct and lymph nodes disection (D2) were carried out. Resected material disclosed that the gallbladder wall thickened at the fundus and the stones strongly adhered to the wall. Histopathologically, xanthogranulomatous cholangitis (XGC) was revealed, and the stones connected with the gallbladder wall via necrosed tissue of ulcer and granulation tissue.<br>In a clinical study of our cases involving previous three cases, all cases had been diagnosed as gallbladder cancer preoperatively and underwent an extended surgery. The disease presents difficulty in differential diagnosis from gallbladder cancer on imagings, and there are cases of both diseases simultaneously. Accordingly, in instances in which gallbladder cancer is suspected, we must bear a possibility of the disease in mind and select carefully operative procedure.

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