Multidetector Computed Tomographic Findings of Xanthogranulomatous Cholecystitis: Correlation with Histopathologic Findings

Objective: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis that is characterized by xanthogranulomas, severe fibrosis, and foam cells. We aimed to evaluate the features of xanthogranulomatous cholecystitis revealed via multidetector computed tomography (MDCT) and correlate the imaging findings with various pathologic findings. Material and Methods: A retrospective analyses was done in 19 patients with pathologically diagnosed XGC between January 2002 and July 2008. Preoperative MDCT examinations were evaluated in all patients. The following MDCT features were evaluated: maximum wall thickness, patterns of wall thickening and enhancement, intramural hypodense nodules, preservation of the mucosal line, presence of stones, surrounding fat and liver. Results: The most characteristic MDCT findings were thickening of the gallbladder wall (100%), the presence of intramural hypodense nodules (100%), and preservation of the mucosal line (79%). Microscopically, the thickened gallbladder wall consisted of proliferation of foamy cells and fibrous tissue with infiltration of inflammatory cells in all patients (100%). Intramural hypodense areas on the wall on MDCT were microscopically composed of xanthogranulomas consisting of foamy histiocytes and inflammatory cells in 79% of the patients. Microscopic examination revealed preservation of the epithelial layer in 68% of the patients. Our results indicate that MDCT findings correlate well with the histopathologic findings of XGC. Conclusion: Although the preoperative imaging diagnosis of XGC is difficult, characteristic MDCT findings are highly suggestive for the diagnosis of XGC.