黄色肉芽肿性胆囊炎12例临床病理分析

Xanthogranulomatous cholecystitis: a clinicopathological study of 12 cases

目的 探讨黄色肉芽肿性胆囊炎 (XGC)的临床病理特点。方法 对 4 81例胆囊切除标本中病理确诊的 12例XGC进行回顾性分析。结果 12例XGC临床表现与一般的慢性胆囊炎胆石症类似。大体观察示胆囊壁明显不规则增厚 ,多数病例切面可见淡黄或黄褐色大小不等的结节或斑点 ,有的呈息肉样突起。镜下观察胆囊壁的正常结构受到不同程度的破坏 ,代之以特征性肉芽肿性结构 ,由大量泡沫样组织细胞、急慢性炎症细胞、纤维母细胞、异物巨细胞和Touton巨细胞等组成。结论 XGC的临床表现难与一般的慢性胆囊炎、胆石症或胆囊癌鉴别 ,但多有慢性胆囊炎急性发作表现。

Objective To study the clinicopathological features of xanthogranulomatous cholecystitis (XGC). Methods Retrospective histopathologic analysis was performed in 12 cases of XGC arisen from 481 cholecystectomy specimens from 1998 to 2001 in this hospital. Results The clinical manifestation of the patients with XGC was similar to that of the ordinary chronic cholecystitis or cholelithiasis. Ultrasonic examination showed enlargement of gallbladder, irregular thickness of the wall and gallstones. Grossly, the thickened wall of gallbladder was surrounded by fibrous adhesions, which were often extensive and attached to the adjacent structures. Cross section through the wall revealed yellowish or brown in color and nodular or macular lesions in majority of the cases. Intraoperative frozen section was performed in 3 cases with suspicious malignancy. Microscopically, there were two types of the lesion, focal (10 cases) and diffuse (2 cases) destructive inflammatory processes with a varying portion of foamy histiocytes, acute and chronic inflammatory cells, Touton multinucleated giant cells and fibroblasts. Conclusions It may be difficult to distinguish XGC from conventional chronic cholecystitis, cholelithiasis and carcinoma of the gallbladder clinically. Pathological confirmation of the diagnosis is always needed.