Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report

BACKGROUND Xanthogranulomatous inflammation(XGI)is an uncommon process involving an accumulation of inflammatory cells,commonly lipid-laden macrophages.XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract.We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum,in which the patient had an initial diagnostic laparoscopy,continued to have symptoms,then proceeded to have the definitive treatment.To our knowledge,this is the first report of XGI associated with a prior small bowel anastomosis.CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers.She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior.Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis.She underwent a laparotomy,resection of the prior anastomosis and re-anastomosis,with final histopathological examination findings consistent with mural XGI.CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.

Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis. The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas. Three patients presented mass lesions that infiltrated the hepatic hilum,provoked biliary dilatation and jaundice,and were indicative of malignancy. Surgical excision was performed following oncological principles and included extirpation of the gallbladder,extrahepatic bile duct,and hilar lymph nodes,as well as partial hepatectomy. Postoperative morbidity was minimal. Surgical pathology demonstrated XGC and absence of malignancy in all three cases. All three patients are alive and well after years of follow-up. XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology. In such cases,the best option may be radical resection following oncological principles performed by expert surgeons,in order that postoperative complications may be minimized if not avoided altogether.

Xanthogranulomatous cholecystitis: What every radiologist should know

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

Xanthogranulomatous cholecystitis:Difficulty in differentiating from gallbladder cancer

AIM: To compare cases of xanthogranulomatous cholecystitis(XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.METHODS: From April 2000 to December 2013, 6 XGC patients received extended surgical resections. During the same period, 16 patients were proven to have gallbladder(GB) cancer, according to extended surgical resection. Subjects chosen for analysis in this study were restricted to cases of XGC with indistinct borders with the liver as it is often difficult to distinguish these patients from those with advanced GB cancer. We compared the clinical features and computed tomography findings between XGC and advanced GB cancer. The following clinical features were retrospectively assessed: age, gender, symptoms, and tumor markers. As albumin and the neutrophil/lymphocyte ratio(NLR) are prognostic in several cancers, we compared serum albumin levels and the NLR between the two groups. The computerized tomography findings were used to compare the two diseases, determine the coexistence of gallstones, the pattern of GB thickening(focal or diffuse), the presence of a hypoattenuated intramural nodule, and continuity of the mucosal line.RESULTS: Based on the preoperative image findings, we suspected GB carcinoma in all cases includingXGC in this series. In addition, by pathological examination, we found that the group of patients with XGC developed inflammatory disease after surgery. Patients with XGC tended to have abdominal pain(4/6, 67%). However, there was no significant difference in clinical symptoms, including fever, between the two groups. Serum albumin and NLR were also similar in the two groups. Serum tumor markers, such as carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9), tended to increase in patients with GB cancer. However, no significant differences in tumor markers were identified. On the other hand, gallstones were more frequently observed in patients with XGC(5/6, 83%) than in patients with GB cancer(4/16, 33%)(P = 0.0116). A hypoattenuated intramural nodule was found in 3 patients with XGC(3/6, 50%), but in only 1 patient with GB cancer(1/16, 6%)(P = 0.0024). The GB thickness, continuous mucosal line, and bile duct dilatation showed no significant differences between XGC and GB cancer.CONCLUSION: Although XGC is often difficult to differentiate from GB carcinoma, it is possible to obtain an accurate diagnosis by careful intraoperative gross observation, and several intraoperative frozen sections.

Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma:An analysis of 42 cases

AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis(XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma(GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section(FS) analysis and surgical procedure data of these patients were collected and analyzed.RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven(17%) cases presented with mild jaundice without choledocholithiasis. Thirtyfive(83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29(69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40(95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups(21% vs 20%, P > 0.05).CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide apractical and effective standard in the differential diagnosis between XGC and GBC.

Xanthogranulomatous cholecystitis:a premalignant condition?

BACKGROUND:Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis,characterized by marked thickening of the gallbladder wall and dense local adhesions.It often mimics a gallbladder carcinoma(GBC), and may coexist with GBC,leading to a diagnostic dilemma. Furthermore,the premalignant nature of this entity is not known.This study was undertaken to assess the p53,PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation. METHODS:Sections from paraffin-embedded blocks of surgically resected specimens of GBC(69 cases),XGC(65), chronic cholecystitis(18)and control gallbladder(10)were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin.p53 expression was scored as the percentage of nuclei stained.PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining(1-3).A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous,cytoplasmic or nuclear staining. RESULTS:p53 mutation was positive in 52%of GBC cases and 3%of XGC,but was not expressed in chronic cholecystitis and control gallbladders.p53 expression was lower in XGC than in GBC(P<0.0001).PCNA expression was seen in 65%of GBC cases and 11%of XGC,but not in chronic cholecystitis and control gallbladders.PCNA expression was higher in GBC than XGC(P=0.0001),but there was no significant difference between the XGC,chronic cholecystitis and control gallbladder groups.Beta-catenin expression was positive in the GBC,XGC, chronic cholecystitis and control gallbladder groups.But the expression pattern in XGC,chronic cholecystitis and control gallbladders was homogenously membranous,whereas in GBC the membranous expression pattern was altered to cytoplasmic and nuclear.CONCLUSION:The expression of p53,PCNA and beta-catenin in XGC was significantly different from GBC and similar to chronic cholecystitis,thus indicating the inflammatory nature of XGC and may not support a premalignant nature of the lesion.

Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.

Surgical treatment of xanthogranulomatous cholecystitis:experience in 33 cases

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC. METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5: 1). RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients. CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.

Presentation and surgical management of xanthogranulomatous cholecystitis

Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,distinguishing XGC from gallbladder cancer preoperatively is still a challenge.The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC.Data sources:The present systematic review was designed using the PRISMA and AMSTAR guidelines.We searched MEDLINE,Scopus,Clinicaltrials.gov,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June 2020.Results:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for XGC.An important conversion rate(35%)was observed as well.The XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome.In addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for XGC.Conclusions:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder cancer.The mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.

Xanthogranulomatous pancreatitis treated by duodenum-preserving pancreatic head resection

BACKGROUND:Xanthogranulomatosis is an idiopathic,rare process in which lipid-laden histiocytes are deposited at various locations in the body.We present two cases who were treated by duodenum-preserving pancreatic head resection and eventually diagnosed as having xanthogranulomatous pancreatitis. METHODS:A 30-year-old caucasian man was admitted to our clinic for vague abdominal pain and epigastric dullness. Magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography suggested the existence of chronic pancreatitis.Another 34-year-old caucasian woman was admitted to our clinic because of right upper quadrant pain. Magnetic resonance cholangiopancreatography demonstrated a dilatation and stone of the main pancreatic duct.Based on a diagnosis of chronic pancreatitis,pancreatic head resection was planned and a laparotomy was performed in both of cases. RESULTS:In both cases,duodenum-preserving pancreatic head resection was performed.Macroscopic and microscopic findings revealed xanthogranulomatous inflammation,which led to a diagnosis of xanthogranulomatous pancreatitis. CONCLUSION:Although this type of pancreatitis is extremely rare,it is important to keep it in mind for a differential diagnosis because it may simulate chronic pancreatitis or a malignant tumor on imaging.

Xanthogranulomatous appendicitis: A comprehensive literature review

BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.

Xanthogranulomatous Cystitis Presenting as Urinary Incontinence and a Vesicovaginal Fistula: a Case Report and Review of the Literature

Anthogranulomatous cystitis (XC) is an inflammatory condition of the urinary bladder that is benign and rarely seen. XC is a unique disease in which there have been only 26 cases described in the literature, including our case. Patients with XC often present with lower urinary tract symptoms, hematuria, abdominal pain, or abdominal mass. We present the unusual case of an 81 year old female who presents with urinary incontinence, which was later diagnosed as a vesicovaginal fistula. After describing the treatment of this patient, a review of the literature is detailed including presentation, possible etiologies, and treatment of XC.

Xanthogranulomatous Pyelonephritis Associated with Crohn’s Disease and Primary Hyperparathyroidism

We report on a case of unilateral and diffuse xanthogranulomatous pyelonephritis (XGP) associated with Crohn’s disease and primary hyperparathyroidism (HPT). The patient had undiagnosed primary HPT for at least a year prior to presentation. The co-existence of Crohn’s disease and primary HPT caused calcium oxalate stone likely by the known mechanism of hypercalcemia and hyperoxaluria respectively. The patient developed XGP, a rare disease, as a result of infected calcium oxalate stone which was treated with antibiotics and unilateral nephrectomy. To the best of our knowledge, this is the first case of XGP associated with Crohn’s disease and primary HPT.

Differential Diagnosis between the Gallbladder Cancer and Xanthogranulomatous Cholecystitis by Multiple Percutaneous Biopsies

Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic inflammatory disease that is often mistaken for gallbladder (GB) cancer. Differential diagnosis based on clinical features or imaging scan is virtually impossible and pathological confirmation is crucial for diagnosis. A 72-year-old man was referred to an oncologist for suspicion of unresectable GB cancer with liver metastasis. He was admitted and underwent three percutaneous needle biopsies. However, all specimens showed non-neoplastic hepatic parenchyma with the third biopsy indicating xanthogranulomatous inflammation with abscess formation. The final biopsy changed the diagnosis from GB cancer to XGC. He was prescribed oral antibiotics and discharged after multiple ERBD stenting because of benign biliary stricture. He regularly visited an outpatient clinic and a follow-up CT scan showed a decrease of gallbladder mass. In conclusion, xanthogranulomatous cholecystitis should be considered in the differential diagnoses of GB mass and clinical suspicion is very important for a precise diagnosis.

Xanthogranulomatous Inflammation of Myometrium Causing Pelvic Extension: Report of Two Cases

Background: Xanthogranulomatous inflammation of the female reproductive organs is a rare chronic inflammation. In most reported cases, the lesion was limited to the endometrium and fallopian tubes. Here, we report two cases of xanthogranulomatous inflammation of the myometrium with a history of endometrial biopsy. Case Reports: In two cases, myometrial xanthogranulomatous inflammation destroyed the myometrium. This inflammation developed into surrounding pelvic organs, resulting in uterine perforation. Conclusion: When inflammatory lesions are found after intrauterine manipulation, the possibility of developing xanthogranulomatous inflammation should be considered. If antibiotics are ineffective, prompt surgical treatment is necessary.

Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis:A singlecenter analysis of outcomes and predictors of surgical approaches and complications

Background:The aim ofthis study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis(XGP)in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications.Materials and methods:We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy(ON)or laparoscopic simple nephrectomy(LN)from January 2014 to April 2020.The primary endpoint was the evaluation of perioperative outcomes and complications.Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications.Results:Overall,44 out of 67 patients(65.67%)underwent ON,while 23(34.33%)underwent LN.Patients in the ON group experienced more postoperative pain according to the visual analogic scale(p=0.032).Moreover,time to deambulation and time to return to full daily activities,assessed according to the 12-ltem Short Form Survey physical and mental component summary scores questionnaires,were significantly shorter in the LN group(p=0.021,p<0.001,and p<0.001,respectively).Of note,there were no significant differences in intraoperative and postoperative complication rates among the groups(p=0.258 and p=0.317,respectively).No conversion to open surgery was described.Logistic regression analysis demonstrated that urgency(p=0.025)was the only predictor associated with a higher risk of intraoperative complications.However,no independent factors associated with postoperative complications or with the surgical approach of choice were found.Conclusions:Based on our results,laparoscopic treatment of XGP represents a feasible alternative to ON,resulting in less postoperative pain and faster recovery.In skilled hands,LN should be considered as the treatment of choice for XGP.

Strategies for diagnosis of xanthogranulomatous cholecystitis masquerading as gallbladder cancer

Background Patients with xanthogranulomatous cholecystitis sometimes exhibit imaging and intraoperative findings that are similar to those of advanced gallbladder cancer,thus these patients are easily misdiagnosed.The present study aimed to investigate the characteristics of xanthogranulomatous cholecystitis masquerading as gallbladder cancer that could potentially aid in the correct diagnosis of this condition.Methods The clinical,serological,radiological and operative features of twelve patients with obviously wall-thickening or mass-forming xanthogranulomatous cholecystitis were retrospectively analyzed.Additionally,the patient preoperative features were compared to those of 36 patients with advanced gallbladder cancers.Results Twelve patients with xanthogranulomatous cholecystitis exhibited one to three episodes of acute cholecystitis within 0.5 to 7 months prior to admission to the hospital.Five of these patients exhibited concomitant choledocholithiasis,whereas no concomitant choledocholithiasis was identified in patients with advanced gallbladder cancer.The incidence of abdominal pain （x2=6.588,P=0.010）,acute cholecystitis （x2=29.176,P=0.000）,acute cholangitis （x2=6.349,P=0.012）,choledocholithiasis （x2=16.744,P=0.000）,carcinoembryonic antigen test （P=0.007）,CA125 （P=0.001）,and diffuse gallbladder wall thickening （x2=6.031,P=0.014）,continued mucosal line （x2=15.745,P=0.000）,homogeneous enhancement of mucosal line （x2=19.947,P=0.000）,submucosal hypoattenuated nodules or band （x2=18.607,P=0.000） in computed tomography demonstrated statistically significant differences between cases of xanthogranulomatous cholecystitis and gallbladder cancer.Furthermore,all the twelve patients with xanthogranulomatous cholecystitis exhibited at least one positive computed tomography imaging feature aside from past acute cholecystitis episode,and no patient with advanced gallbladder cancer simultaneously exhibited past acute cholecystitis episode and at least one positive computed tomography imaging feature.Conclusions The accurate preoperative diagnosis of xanthogranulomatous cholecystitis includes an integrated review of past acute cholecystitis episode,choledocholithiasis,and positive computed tomography imaging features.Besides,we present an algorithm for intraoperative diagnosis.

Xanthogranulomatous Cholecystitis and Misdiagnosis Analysis

INTRODUCTION Gastric sub-epithelial masses （SEMs） are relatively common findings when receiving gastric endoscopy. It is a mass, bulge, or impression visible. Computed tomography （CT） and magnetic resonance imaging can assist in making a diagnosis,

Imaging-based algorithmic approach to gallbladder wall thickening

Gallbladder(GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma(GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities(conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.