黄色肉芽肿性胆囊炎41例临床病理分析

Xanthogranulomatous cholecystitis: a clinicopathological study of 41 cases

目的 :探讨黄色肉芽肿性胆囊炎 (XGC)临床病理特点及发病机制 ,以提高对本病的认识。方法 :对 4 1例经病理确诊的XGC进行常规HE片观察 ,部分病例作免疫组化染色。结果 :4 1例XGC临床表现缺乏特异性。CT显示胆囊壁增厚与壁内低密度结节。术中可因胆囊壁增厚或结节 /肿块及与周围器官粘连或内瘘形成 ,而误诊为癌。病理眼观见胆囊壁黄色结节或肿块 ,镜下见重度急慢性炎症背景上有特征性泡沫细胞肉芽肿形态。结论 :XGC可能是由胆囊炎症、结石嵌顿和胆汁淤积因素所诱导 ,与免疫反应有关的迟发性肉芽肿病变。少数病例 ,可伴发腺癌 。

Purpose To study the clinical and pathological characteristics and mechanism of xanthogranulomatous cholecystitis (XGC), so as to deepen our understanding of this disease. Method HE sections were reviewed in 41 cases of XGC and immunohistochemical stain was used for 4 cases. Results 41 cases of XGC were short of peculiar clinical manifestation. CT examination indicated the thickening cholecystic paries and tubercles of low density in the paries. In operation, owing to the thickening cholecystic paries, some tubercles or tumors which were subject to adhere to the surrounding tissues or organs and to form an internal fistula, it was very easy to mis diagnose them as cancer. Grossly, yellow tubercles or tumors on the cholecystic paries could be seen. The foam cell granuloma on the background of the severe acute and chronic inflammation was the characteristic pattern. Conclusions XGC is possibly induced by the inflammation, obstruction of calculus and cholestasis of the gallbadder. The delayed granuloma relates to immunoreaction. A few of cases can accompanied with adenocarcinoma and should be paid attention.