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Journal Africain d'Hépato-Gastroentérologie

1954-3204
 

 ARTICLE VOL 5/1 - 2011  - pp.43-45  - doi:10.1007/s12157-010-0217-3
TITRE
La cholécystite xanthogranulomateuse, un diagnostic histologique inattendu: à propos d’un cas

TITLE
Xanthogranulomatous cholecystitis, an unexpected histologic diagnosis

RÉSUMÉ

La cholécystite xanthogranulomateuse est une forme rare de cholécystite chronique qui par sa présentation clinique, radiologique et même macroscopique peut simuler un cancer de la vésicule biliaire. Le diagnostic final reste souvent histologique sur la pièce opératoire après cholécystectomie. Nous rapportons l’observation d’un homme de 71 ans, sans antécédents pathologiques notables, qui a été opéré avec le diagnostic de cancer de la vésicule biliaire. La laparotomie exploratrice montrait une tumeur de la vésicule biliaire envahissant le foie sur environ deux centimètres. Le patient a subi une cholécystectomie associée à une bisegmentectomie IV et V et à un curage du pédicule hépatique. L’examen anatomopathologique de la pièce opératoire a conclu à une cholécystite xanthogranulomateuse. Avec un recul de huit mois, le patient était totalement asymptomatique et son examen physique était normal.



ABSTRACT

Xanthogranulomatous cholecystitis (XC) is an uncommon form of chronic inflammation of the gallbladder characterized by a thickening of the gallbladder wall. It may clinically and radiographically mimic gallbladder carcinoma. In spite the progress of imagery, preoperative diagnosis is still often difficult which can lead to inappropriate extended surgery. We herein report the clinical presentation of a 71-year-old man with no medical history who was admitted to our department with a chief complaint of intermittent pain in his right upper abdomen, radiating to the back since a year. There was no history of jaundice, fever, anorexia, or weight loss. Physical examination revealed no signs of cholecystitis. Routine laboratory tests including white cell counts were within normal ranges. For further examination, we performed an abdominal ultrasonography. It revealed a thickening of the gallbladder wall on the hepatic side. There was no associated biliary dilatation or gallstones. CT scan of the abdomen showed similar findings with regional enlarged lymph nodes. The boundary of the gallbladder and liver parenchyma was ill defined. The patient was discharged in good condition on the 7th day following surgery. He is now in good health eight months after surgery. As imaging findings were strongly suggestive of malignancy, we decided to perform a radical surgery. Peroperative finding shows a gallbladder mass invading the liver bed with some regional lymph nodes. We performed subsegmentectomy of the liver S4a + S5 and lymph node dissection. Histological examination showed diffuse chronic inflammatory cell infiltration with focal lipid-laden macrophage accumulation in the gallbladder wall and conclude on chronic xanthogranulomatous cholecystitis with no evidence of malignancy. The patient was discharged in good condition on the 7th day following surgery. He is now in good health 8 months after surgery. Xanthogranulomatous cholecystitis is a rare destructive inflammatory disease of the gallbladder which may be indistinguishable from a malignant neoplasm on the basis of imaging findings. The clinical presentation is similar to that of cholecystitis. A correct preoperative diagnosis of XC is important to avoid unnecessary laparotomy.



AUTEUR(S)
H. MAGHREBI, R. BEDOUI, R. NOUIRA, C. DZIRI

MOTS-CLÉS
Cholécystite xanthogranulomateuse, Vésicule biliaire, Cholécystectomie, Tomodensitométrie

KEYWORDS
Xanthogranulomatous cholecystitis, Gallbladder, Cholecystectomy, Computed tomography

LANGUE DE L'ARTICLE
Français

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