Abstract
Xanthogranulomatous cholecystitis (XGC) is sometimes difficult to differentiate from gallbladder carcinoma. We reported a case of XGC with carcinoma of papilla Vater diagnosed by percutaneous transhepatic cholecystoscopy (PTCCS) and by duodenoscope. This patients was a 50-year-old male with a complaint of upper abdominal pain. Abdominal ultrasonography (US) showed thickend gallbladder wall with nodular hyper echoic area with a stone shadow in it. Contrast enhanced computed tomography (CT) showed nodular low density area (LDA) in the gallbladder wall. Percutaneous transhepatic cholecystography (PTCC) showed rigid gallbladder wall and leakage of the contrast material into gallbladder bed. PTCCS showed almost normal gallbladder mucosa and therefore, diagnosed this lesion as not the carcinoma but XGC. Duodenoscopy revealed carcinoma of papilla Vater. Pancreatoduodenectomy with cholecystectomy was performed. Resected specimen showed that yellow nodules observed intra-gallbladder wall were xanthogranuloma and had been well visualized with US as nodular hyper echoic area and CT as nodular low density area. The rigid gallbladder wall and the leakage of the contrast material into the gallbladder bed observed by PTCC were also the characteristic findings of XGC. Microscopic findings of papillary tumor of papilla Vater showed papillary adenocarcinoma located in the mucosal layer and no lymph node metastasis. This patient has been well for one year and ten months after the operation.
