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Xanthogranulomatous Cholecystitis Mimicking Biliary Tract Cancer.

Mohamad B, Bhatt A, Kumaravel A, Aucejo F, Jang S, Stevens T, Vargo J, Parsi M - ACG Case Rep J (2015)

Bottom Line: Laboratory tests revealed elevated liver enzymes and CA19-9.Imaging showed dilation of both the intra- and extrahepatic bile ducts, narrowing of the bile duct at the junction of the common bile duct and common hepatic duct, and a hypoechoic mass involving the neck of the gallbladder and the muscularis propria of the duodenum.Examination of the resected gallbladder and perihilar nodes ruled out malignancy and revealed a diffuse inflammatory infiltrate of giant histiocytes with clear, lipid-containing cytoplasm (xanthoma cells), consistent with xanthogranulomatous cholecystitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.

ABSTRACT
We present a 42-year-old man with a 1-month history of painless jaundice, dark urine, clay-colored stools, and a 13.5-kg weight loss. Laboratory tests revealed elevated liver enzymes and CA19-9. Imaging showed dilation of both the intra- and extrahepatic bile ducts, narrowing of the bile duct at the junction of the common bile duct and common hepatic duct, and a hypoechoic mass involving the neck of the gallbladder and the muscularis propria of the duodenum. Examination of the resected gallbladder and perihilar nodes ruled out malignancy and revealed a diffuse inflammatory infiltrate of giant histiocytes with clear, lipid-containing cytoplasm (xanthoma cells), consistent with xanthogranulomatous cholecystitis.

No MeSH data available.


Related in: MedlinePlus

EUS view of hypoechoic mass involving (A) the neck of the gallbladder and (B) the muscularis propria layer of the duodenum.
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Figure 2: EUS view of hypoechoic mass involving (A) the neck of the gallbladder and (B) the muscularis propria layer of the duodenum.

Mentions: Abdominal ultrasound showed a 2.7-cm gallstone impacted in the gallbladder neck, with dilation of both the intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatogram (ERCP) revealed narrowing of the bile duct at the junction of the common bile duct and common hepatic duct with dilation of the biliary tree proximal to the narrowing (Figure 1). Mirizzi syndrome was suspected and a magnetic resonance cholangiopancreatography (MRCP) showed an enhancing, infiltrative, mass-like process centered on the neck of the gallbladder and the cystic duct. An endoscopic ultrasound (EUS) demonstrated a 2.6 x 1.6-cm hypoechoic mass involving the neck of the gallbladder and the muscularis propria layer of the duodenum, raising suspicion of a gastrointestinal stromal tumor (Figure 2). There was a 1-cm lymph node in the periportal region. Fine-needle aspiration (FNA) was performed on both the mass and the lymph node. Cytology results from the mass showed chronic inflammation with numerous histiocytes, and cytology results from the lymph node showed benign lymph node tissue.


Xanthogranulomatous Cholecystitis Mimicking Biliary Tract Cancer.

Mohamad B, Bhatt A, Kumaravel A, Aucejo F, Jang S, Stevens T, Vargo J, Parsi M - ACG Case Rep J (2015)

EUS view of hypoechoic mass involving (A) the neck of the gallbladder and (B) the muscularis propria layer of the duodenum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612761&req=5

Figure 2: EUS view of hypoechoic mass involving (A) the neck of the gallbladder and (B) the muscularis propria layer of the duodenum.
Mentions: Abdominal ultrasound showed a 2.7-cm gallstone impacted in the gallbladder neck, with dilation of both the intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatogram (ERCP) revealed narrowing of the bile duct at the junction of the common bile duct and common hepatic duct with dilation of the biliary tree proximal to the narrowing (Figure 1). Mirizzi syndrome was suspected and a magnetic resonance cholangiopancreatography (MRCP) showed an enhancing, infiltrative, mass-like process centered on the neck of the gallbladder and the cystic duct. An endoscopic ultrasound (EUS) demonstrated a 2.6 x 1.6-cm hypoechoic mass involving the neck of the gallbladder and the muscularis propria layer of the duodenum, raising suspicion of a gastrointestinal stromal tumor (Figure 2). There was a 1-cm lymph node in the periportal region. Fine-needle aspiration (FNA) was performed on both the mass and the lymph node. Cytology results from the mass showed chronic inflammation with numerous histiocytes, and cytology results from the lymph node showed benign lymph node tissue.

Bottom Line: Laboratory tests revealed elevated liver enzymes and CA19-9.Imaging showed dilation of both the intra- and extrahepatic bile ducts, narrowing of the bile duct at the junction of the common bile duct and common hepatic duct, and a hypoechoic mass involving the neck of the gallbladder and the muscularis propria of the duodenum.Examination of the resected gallbladder and perihilar nodes ruled out malignancy and revealed a diffuse inflammatory infiltrate of giant histiocytes with clear, lipid-containing cytoplasm (xanthoma cells), consistent with xanthogranulomatous cholecystitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.

ABSTRACT
We present a 42-year-old man with a 1-month history of painless jaundice, dark urine, clay-colored stools, and a 13.5-kg weight loss. Laboratory tests revealed elevated liver enzymes and CA19-9. Imaging showed dilation of both the intra- and extrahepatic bile ducts, narrowing of the bile duct at the junction of the common bile duct and common hepatic duct, and a hypoechoic mass involving the neck of the gallbladder and the muscularis propria of the duodenum. Examination of the resected gallbladder and perihilar nodes ruled out malignancy and revealed a diffuse inflammatory infiltrate of giant histiocytes with clear, lipid-containing cytoplasm (xanthoma cells), consistent with xanthogranulomatous cholecystitis.

No MeSH data available.


Related in: MedlinePlus