The Diagnostic Mirage: Xanthogranulomatous Cholecystitis and the Illusion of Gallbladder Carcinoma
Abstract
Xanthogranulomatous cholecystitis (XGC) is an uncommon chronic inflammatory disease of the gallbladder that frequently mimics gallbladder carcinoma because of its overlapping clinical, radiological, and intraoperative features. Establishing a definitive preoperative diagnosis remains challenging, and intraoperative frozen section examination can aid surgical decision-making in patients with indeterminate gallbladder lesions while avoiding unnecessary radical resection. We present a case of a 49-year-old man with poorly controlled type 2 diabetes mellitus who presented with intermittent upper abdominal pain, low-grade fever, generalised pruritus, and insignificant weight loss. Initial ultrasonography demonstrated focal wall thickening involving the fundus and body of the gallbladder without definite sonographic features suggestive of malignancy. To rule out other intra-abdominal causes of his symptoms, contrast-enhanced computed tomography was performed, followed by magnetic resonance cholangiopancreatography (MRCP), which demonstrated focal asymmetric wall thickening involving the fundus and distal body of the gallbladder with diffusion restriction, raising suspicion for gallbladder carcinoma. Routine biochemical investigations were largely unremarkable except for elevated alkaline phosphatase, while serum tumour markers (CEA (carcinoembryonic antigen), CA 19-9 (carbohydrate antigen 19-9), and AFP (alpha-fetoprotein) ) were within normal limits. The patient underwent…
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