A 83-year-old woman complaining of right hypochondralgia was transferred to our hospital for further examination from her home doctor. Investigations revealed leucocytosis, elevation of hepatobiliary enzymes, CRP and CA19-9. Abdominal US revealed heterogeneous hyperechoic mass with hypoechoic lesions and stone with acoustic shadow in the neck of the gallbladder. Abdominal CT scans showing hypovascular area in the thickening gallbladder wall and suspect of infiltrating to the duodenum. Endoscopic findings revealed edematous mucosa and stenosis of duodenum, with partially yellowish mucosa. Operation was performed under the diagnosis of gallbladder cancer infiltrating to the duodenum. The gallbladder appeared extensive adhesions was found to such adjacent organs as liver and duodenum. Diagnosis was gallbladder cancer invasion to the liver and duodenum based on operative findings. Cholecystectomy with partial hepatic resection of the gallbladder bed and a partial resection of the duodenum was done. Surgical specimen revealed marked thickened yellowish wall, the stone was impacted in the neck and made fistula to the duodenum. Histopathological findings revealed foamy histiocytes, inflammatory cells in the thickened gallbladder wall. Xanthogranulomatous cholecystitis was diagnosed. When we observed yellowish mucosa of the duodenum in GFS, xanthogranulomatous cholecystitis must be considered as one of diffential diagnosis.
