Diagnostic and therapeutic challenges in xanthogranulomatous cholecystitis: A rare case report

ABSTRACT Introduction and importance: Xanthogranulomatous cholecystitis (XGC) is a rare, aggressive gallbladder condition marked by chronic inflammation, fibrosis, and lipid-laden macrophages. It often mimics gallbladder carcinoma clinically and radiologically, complicating diagnosis and treatment. Early differentiation from malignancy is essential for proper management. This case emphasizes the diagnostic challenges of XGC and the need for a multidisciplinary approach. Case presentation: A 61-year-old man presented with four months of intermittent right upper quadrant abdominal pain radiating to the back, without fever, jaundice, or weight loss. Examination revealed right hypochondrial tenderness, and labs showed elevated inflammatory markers. Imaging indicated gallstones, gallbladder wall thickening, and ill-defined liver boundaries, raising malignancy concerns. A biopsy confirmed xanthogranulomatous cholecystitis (XGC), ruling out carcinoma. He underwent successful laparoscopic cholecystectomy, with histopathology confirming XGC. Recovery was uneventful, and he remained symptom-free at six-month follow-up. Clinical discussion: XGC is a diagnostic challenge due to its nonspecific symptoms and imaging findings that overlap with malignancy. Preoperative biopsy, as performed in this case, can be invaluable in guiding management. Laparoscopic cholecystectomy, though technically demanding due to dense adhesions and local invasion, is feasible in selected cases. Histopathology remains the gold standard for definitive diagnosis, revealing chronic inflammation and lipid-laden macrophages without malignancy. Conclusion: This case underscores the importance of considering XGC in the differential diagnosis of gallbladder masses, particularly when imaging suggests local invasion. Preoperative biopsy and histopathology play pivotal roles in distinguishing XGC from malignancy. Successful laparoscopic management, despite its challenges, highlights the potential for minimally invasive surgery in carefully selected cases. Highlights