Xanthogranulomatous cholecystitis masquerading as colon cancer: A case report

Abstract

Significance: Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis commonly mistaken for gallbladder cancer. We present a case of XGC that masqueraded as colon cancer. There has been no report to date where XGC propounded as such. Familiarity of this presentation may contribute to prompt diagnosis and adequate treatment.

Clinical Presentation: A 59-year-old male with remote history of choledocholithiasis removed by endoscopic retrograde cholangiopancreatography presented with anorexia, weight loss, chronic right upper quadrant pain and a palpable mass.

Management: Abdominal CT revealed an ill-defined hepatic flexure mass intimately related to the gallbladder, with loss of delineation of the gallbladder from the liver bed. Colonoscopy was done revealing a nodular, ill defined mass at the hepatic flexure. Biopsies of this lesion revealed chronic active colitis with reactive epithelial changes, and an ulcer with granulation tissue. A multidisciplinary team was convened to manage the case. The patient successfully underwent laparotomy, extended right hemicolectomy, and en bloc cholecystectomy with liver resection. Gross examination of the specimen showed a cholecystocolic fistula. Final histopathologic examination, however, revealed xanthogranulomatous cholecystitis with adenomyomatosis, without evidence of malignancy.

Recommendation: This report shows that XGC can potentially masquerade as colon cancer. A high index of suspicion and a multidisciplinary approach are critical in the proper management of perplexing yet challenging cases such as this one. Extensive surgery may be reasonable where there is suspicion for malignancy and/or multiorgan involvement.