Question:

Which of the following are true?
1. It is important to differentiate xanthogranulomatous cholecystitis from gallbladder adenomyomatosis by imaging, if possible, to guide clinical management.
2. Inflammatory changes outside and surrounding the gallbladder wall should raise the suspicion of xanthogranulomatous cholecystitis or gallbladder carcinoma.
3. Both xanthogranulomatous cholecystitis and gallbladder carcinoma are best treated by open cholecystectomy.
4. Complications in treating xanthogranulomatous cholecystitis and gallbladder carcinoma surgically are related to intense fibrosis leading to unclear surgical anatomy.
5. None of the above choices are true.





Answer:

The correct answers for the question "Which of the following are true?" are:

1. It is important to differentiate xanthogranulomatous cholecystitis from gallbladder adenomyomatosis by imaging, if possible, to guide clinical management.

2. Inflammatory changes outside and surrounding the gallbladder wall should raise the suspicion of xanthogranulomatous cholecystitis or gallbladder carcinoma.

3. Both xanthogranulomatous cholecystitis and gallbladder carcinoma are best treated by open cholecystectomy.

4. Complications in treating xanthogranulomatous cholecystitis and gallbladder carcinoma surgically are related to intense fibrosis leading to unclear surgical anatomy.



Explanation
a. It is important to differentiate XGC from GBAM by imaging, if possible, to guide clinical management. [Utilizing sonography and computed tomography (CT)/MRI to differentiate XGC from GBAM is important for clinical management.]

b. Inflammatory changes outside and surrounding the gallbladder wall should raise the suspicion of XGC or gallbladder carcinoma.  [Inflammatory changes outside the gallbladder should raise suspicion for XGC or GB carcinoma, both requiring open cholecystecomy to address potential complications resulting from inflammatory changes and scarring.]

c. Both XGC and gallbladder carcinoma are best treated by open cholecystectomy.  [Inflammatory changes outside the gallbladder should raise suspicion for XGC or GB carcinoma, both requiring open cholecystecomy to address potential complications resulting from inflammatory changes and scarring.]

d. Complications in treating XGC and gallbladder carcinoma surgically are related to intense fibrosis leading to unclear surgical anatomy.  [Laparoscopic cholecystectomy, in the presence of XGC, is frequently unsuccessful secondary to unclear surgical anatomy from intense fibrosis leading to higher complication rates.]

e. None of the above choices are true. [All four above choices are true; see corresponding information following each choice.]



From the manuscript:
Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology
Radiology Case. 2011 Apr; 5(4):19-24


This article belongs to the GI section.




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From the manuscript

Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology

Free full text article: Case report of xanthogranulomatous cholecystitis, review of its sonographic and magnetic resonance findings, and distinction from other gallbladder pathology

Abstract
A case of xanthogranulomatous cholecystitis is presented with a brief review of its sonographic and magnetic resonance features. These imaging features are also compared to those seen in gallbladder adenomyomatosis and gallbladder carcinoma. While there are many overlapping imaging findings in these entities, it is important to recognize distinguishing characteristics so a correct surgical approach is chosen. Laparoscopic cholecystectomy attempted with existing xanthogranulomatous cholecystitis has an increased surgical complication rate compared to open cholecystectomy and often necessitates intraoperative conversion to open cholecystectomy.






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