Xanthogranulomatous cholecystitis

Discussion:

It can be challenging to distinguish benign and malignant gallbladder pathology on imaging, and they may coincide. Here the imaging features are typical of xanthogranulomatous cholecystitis, with dilated hypo-enhancing spaces in the wall. The luminal mucosa is intact throughout. 

This is presumed to have occurred secondary to a chronically impacted stone in the neck, raising the intraluminal pressure, and leading to rupture of the Rokitansky-Aschoff sinuses into the wall. 

The patient went on to open cholecystectomy. The pathological specimen demonstrated the typical features of xanthogranulomatous cholecystitis within the wall: foamy lipid-laden macrophages, bile pigment and chronic inflammatory cells. 

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