黄色肉芽肿性胆囊炎

Xanthogranulomatous cholecystitis

目的探讨黄色肉芽肿性胆囊炎（ＸＧＣ）的临床病理特征和诊断。方法对１９８６～１９９６年间从５８５例胆囊病理检查标本中检出的２０例（３．４％）ＸＧＣ作回顾性临床病理观察。结果２０例（男９例，女１１例）ＸＧＣ的临床表现类似一般的慢性胆囊炎或胆石病。手术所见：胆囊壁增厚伴广泛粘连而酷似癌。２０例临床全部误诊。镜下所见：多结节型１０例，局灶型７例，弥漫型３例。胆囊壁内均见典型的泡沫细胞肉芽肿或胆汁肉芽肿。结论ＸＧＣ临床诊断困难，确诊和与胆囊癌的鉴别主要靠病理检查。对可疑病例术中冰冻切片检查是必要的。对所有切除的胆囊都应送病理检查，以防漏诊或误诊。

Objective To study the clinicopathological features and diagnosis of the xanthogranulomatouscholecystitis (XGC). Methods A clinicopathological analysis of 20 cases (3.4%) with XGC selected from 585histopathologically examined cholecystectomy specimens between 1986 and 1996 were performed retrospectively.Results The 20 patients comprised 9 men and 11 women, aged from 32 to 74 (mean 50. 5) years. The clinicalPresentation was similar to that of general chronic cholecystitis or cholelithiasis. The operative findings showed athickened gallbladder wall with extensive adherence to adjacent organs, and thus, mimicking gallbladder carcino-ma. All the 20 cases were clinically misdiagnosed. Microscopic findings showed multinedular type in 10 cases, fo-cal type in 7 cases and diffuse type in 3 cases. Typical foamy cell granulomas or bile granulomas were found in thegallbladder wall in all cases. Conclusions The XGC was difficult to be diagnosed clinically. Definite diagnosisand differentiation from gallbladder carcinoma mainly depend on histopathological examination. Intraoperativefrozen-section examination is necessary in suspected case. It is recmmended that clinicians should raise diagnosticconsciousness of XGC and that histopathological examination of all cholecystectomy specimens Should be Performedto avoid missed diagnosis or misdiagnosis.