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Ksantogranülomatöz Kolesistit Vakalarının Analizi

Yıl 2018, Cilt: 71 Sayı: 1, 81 - 86, 16.10.2018

Serhat Tokgöz

Öz

Amaç: Ksantogranulomatöz kolesistit (XGC), safra tașı ve safra stazı bağlı gelișen inflamatuar bir durumdur. Patolojik, radyolojik ve klinik özellikleri safra kesesi kanserine benzediğinden, așırı veya yetersiz cerrahi gibi yanlıș tedavilere neden olmaktadır. Bu çalıșmada XGC olgularının klinik ve cerrahi özelliklerini belirlemek amaçlanmıștır.

Gereç ve Yöntem: Kliniğimizde 2008 ile 2015 yılları arasında kolesistektomi yapılan 4818 hastadan XGC tanısı alan 55 hastanın tıbbi kayıtları incelendi.

Bulgular: En sık rastlanan klinik bulgu (% 90) sağ üst kadran ağrısıydı. Hastaların % 30’unda ise akut kolesistit tablosu mevcuttu. Bilier duvar kalınlașması hastaların% 64'ünde bulundu. Laparaskopik kolesistektomiden açığa dönüș oranı ise %39 olarak bulundu ve bu oran tüm kolesistektomilerin konversiyon oranı %3.4 ile karșılaștırıldığında oldukça yüksekti. Postoperatif bilier fistül % 9 ve toplam morbidite ise % 23 olarak tespit edildi.

Sonuç: XGC nadir bir kolesistit formudur. Histolojik olarak benign olmasına rağmen, preoperatif ve intraoperatif tanı agresif seyri nedeniyle zor ve karmașıktır. XGC'de ameliyat sırasında karsinom șüphesi olmasına rağmen ilișkisi çok yüksek değildir. Daha kapsamlı cerrahiden kaçınmak için frozen incelenmesi oldukça yararlıdır. Kesin tedavi ameliyattır ancak ameliyat sırasında ve sonrasında yüksek morbidite oranları olduğu unutulmamalıdır.

Anahtar Kelimeler

Ksantogranülomatöz Kolesistit Konversiyon kolesistektomi

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

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Teşekkür

-

Kaynakça

  • 1) Dixit VK, Parakash A, Gupta A, Pandey M, Gautam A, Kumar M, Shukla VK. Xanthogranulomatous cholecystitis. Dig Dis Sci. 1998 May;43(5):940–942.
  • 2) Gilberto Guzman-Valdivia. Xanthogranulomatous Cholecystitis: 15 years Experience. World J Surg. 2004;28: 254–257.
  • 3) Mori M, Watanabe M, Sakuma M, Tsutsumi Y. Infectious etiology of xanthogranulomatous cholecystitis: Immunohistochemical identification of bacterial antigens in the xanthogranulomatous lesions. Pathol Int. 1999;49:849–852
  • 4) Seiko Sawada, Kenichi Harada, Kumiko Isse, Yasunori Sato, Motoko sasaki, Yasuharu Kaizaki, Yasi Nakanuma. Involvement of Escherichia coli in pathogenesis of xanthogranulomatous cholecystitis with scavenger receptor class A and CXCL16-CXCR6 interaction. Pathol Int. 2007;57:652–663.
  • 5) Goodman Z, Ishak K. (1981) Xanthogranulomatous cholecystitis. Am J Surg Pathol 5:653–659.
  • 6) Roberts K, Parsons M. (1987) Xanthogranulomatous cholecystitis:clinico-pathological study of 13 cases. J Clin Pathol 40:412–417
  • 7) Yoshida J, Chijiiwa K, Shimura H, et al. Xanthogranulomatous cholecystitis versus gallbladder cancer: Clinical differentiating factors. Am Surg. 1997;63(4):367–371.
  • 8) Adachi Y, Iso Y, Moriyama M, et al. Increased serum CA 19-9 in patients with xanthogranulomatous cholecystitis. Hepatogastroenterology. 1998;45(19):77–80.
  • 9) L.-F.Zhang,C.-S.Hou, J.-Y.Liuet al., “Strategies for diagnosisof xanthogranulomatous cholecystitis masquerading as gallbladder cancer,” ChineseMedical Journal, vol. 125, no. 1, pp. 109–113, 2012.
  • 10) Krishnani N, Dhingra S, Kapoor S, Pandey R. (2007) Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases. Acta Cytol 51:37–41.
  • 11) Lee HS, Joo KR, Kim DH, Park NH, Jeong YK, Suh JH et al. (2003) A case of simultaneous xanthogranulomatous cholecystitis and carcinoma of thegallbladder. Korean J Intern Med 18:53–56.
  • 12) Yang T, Zhang B, Zhang J, Zhang Y, Jiang X, Wu M. (2007) Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases. Hepatobiliary Pancreat Dis Int 6:504–508.
  • 13) Kwon AH, Matsui Y, Uemura Y. Surgical Procedures and Histopathologic Findings for Patients with Xanthogranulomatous Cholecystitis. J Am Coll Surg. 2004;199:204–210.
  • 14) Guzman- Valdivia G: Xanthogranulomatous cholecystitis in laparoscopic surgery. J Gastrointest Surg 2005; Apr. 9 (4) : 494–497.
  • 15) Qasaimeh, Ghazi Raji, et al. "Xanthogranulomatous Cholecystitis in the Laparoscopic Era Is Still a Challenging Disease." Journal of Gastrointestinal Surgery 19.6 (2015): 1036-1042.
  • 16) Kwon A-H, Matsui Y, Uemura Y. (2004) Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis. J Am Coll Surg 199:204–210.
  • 17) Chang BJ, Kim SH, Park HY, Lim SW, Kim J, Lee KH et al. (2010) Distinguishing xanthogranulomatous cholecystitis from the wallthickening type of early-stage gallbladder cancer. Gut Liver 4:518–523.
  • 18) Krishna RP, Kumar A, Singh RK, Sikora S, Saxena R, Kapoor VK. (2008) Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: presentation and surgical management. J Gastrointest Surg 12:836–841
  • 19) Ueda J, Yoshıda H, Arıma Y, Mamada Y, Tanıaı N,Mıneta S, Yoshıoka M, Kawano Y, Naıto Z, Uchıda E.A case of xanthogranulomatous cholecystitis preoperativelydiagnosed with contrastenhanced ultrasonography.J Nihon Med Sch 2011; 78: 194-198.
  • 20) Sharma D, Babu R, Sood G, Kapoor G, Solankı RS, Thomas S.Xanthogranulomatous cholecystitis masquerading as malignancy with liver metastasis.ANZ J Surg 2009; 79: 946-947.
  • 21) Hale, Matthew David, et al. "Xanthogranulomatous cholecystitis: a European and global perspective." HPB 16.5 (2014): 448-458.
  • 22) Morera Ocón FJ, Ballestín Vicente J, Ripoll Orts F, Landete Molina F, García-Granero Ximénez M, Millán Tarín J et al. (2009) [Gallbladder cancer in a regional hospital]. Cir Esp 86:219–223.
  • 23) Choi SB, Han HJ, Kim CY, Kim WB, Song T-J, Suh SO et al. (2009) Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 33: 2657–2663.
  • 24) Yamamoto H, Hayakawa N, Kitagawa Y, Katohno Y, Sasaya T, Takara D et al. (2005) Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 12:391–398.
  • 25) Benbow EW, Taylor PM: Simultaneous xanthogranulomatous cholecystitis and primary adenocarcinoma of the gallbladder. Histopathology 1988; 12(6): 672–675.
  • 26) Rammohan, Ashwin, et al. "Xanthogranulomatous cholecystitis masquerading as gallbladder cancer: can it be diagnosed preoperatively?." Gastroenterology research and practice 2014 (2014).
  • 27) Hijioka S, Mekky MA, Bhatia V, Sawaki A, Mizuno N, Hara K et al. (2010) Can EUSguided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc 72:622–627.
  • 28) Heimbach JK, Sanchez W, Rosen CB, Gores GJ. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford). 2011;13:356–360.
  • 29) Sawada, Shigeaki, et al. "Expression of GLUT-1 and GLUT-3 in xanthogranulomatous cholecystitis induced a positive result on 18F-FDG PET: report of a case." International surgery 98.4 (2013): 372-378.
  • 30) Yu H, Yu TN, Caı XJ. Tumor biomarkers: help or mislead in the diagnosis of xanthogranulomatous cholecystitis?- analysis of serum CA 19-9, carcinoembryonic antigen, and CA 12-5. Chin Med J (Engl) 2013; 126: 3044-3047.
  • 31) Krishna RP, Kumar A, Singh RK, Sikora S, Saxena R, Kapoor VK. Xanthogranulomatous inflamantio stricture of extrahepatic biliary tract: Presentation and surgical management. J Gastrointest Surg. 2008;12:836–841.
  • 32) Srikanth G, Kumar A, Khare R, Siddappa L, Gupta A, Sikora SS, et al. Should Laparoscopic Cholecystectomy be performed in patients with thick-walled gallbladder? J Hepatobiliary Pancreat Surg. 2004;11:40–44.

An Analysis of Xanthogranulomatous Cholecystitis Cases

Yıl 2018, Cilt: 71 Sayı: 1, 81 - 86, 16.10.2018

Serhat Tokgöz

Öz

Aim: Xanthogranulomatous cholecystitis (XGC) is usually an inflammatory condition due to gallstones and bile stasis. Pathological, radiological and clinical features are similar to gallbladder cancer, leading to erroneous treatments such as excessive or inadequate surgery. The aim of this study was to identify the clinical and surgical characteristics of XGC cases.

Materials and Methods: The medical records were reviewed of 55 patients diagnosed as XGC from 4818 patients who underwent cholecystectomy between 2008 and 2015.

Results: The most common clinical finding (90%) was right upper quadrant pain, followed by acute cholecystitis (30%). Biliary wall thickening was found in 64% of patients. Conversion to open cholecystectomy rate was 39%, which was significantly higher than that of all cholecystectomies conversion rates 3.4%. Postoperative biliary fistula was determined at 9% and total morbidity at 23%.

Conclusion: XGC is a rare form of cholecystitis. Although it is histologically benign, preoperative and intraoperative diagnosis is difficult and complicated due to its aggressive course. Although carcinoma may be suspected during surgery in XGC, the association is not very high. It is quite useful to study frozen samples
to avoid extensive surgery. The definitive treatment is surgery, but it should not be forgotten that there are high morbidity rates during and after the operation

Anahtar Kelimeler

xanthogranulomatosis cholecystitis conversion cholecystectomy

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1) Dixit VK, Parakash A, Gupta A, Pandey M, Gautam A, Kumar M, Shukla VK. Xanthogranulomatous cholecystitis. Dig Dis Sci. 1998 May;43(5):940–942.
  • 2) Gilberto Guzman-Valdivia. Xanthogranulomatous Cholecystitis: 15 years Experience. World J Surg. 2004;28: 254–257.
  • 3) Mori M, Watanabe M, Sakuma M, Tsutsumi Y. Infectious etiology of xanthogranulomatous cholecystitis: Immunohistochemical identification of bacterial antigens in the xanthogranulomatous lesions. Pathol Int. 1999;49:849–852
  • 4) Seiko Sawada, Kenichi Harada, Kumiko Isse, Yasunori Sato, Motoko sasaki, Yasuharu Kaizaki, Yasi Nakanuma. Involvement of Escherichia coli in pathogenesis of xanthogranulomatous cholecystitis with scavenger receptor class A and CXCL16-CXCR6 interaction. Pathol Int. 2007;57:652–663.
  • 5) Goodman Z, Ishak K. (1981) Xanthogranulomatous cholecystitis. Am J Surg Pathol 5:653–659.
  • 6) Roberts K, Parsons M. (1987) Xanthogranulomatous cholecystitis:clinico-pathological study of 13 cases. J Clin Pathol 40:412–417
  • 7) Yoshida J, Chijiiwa K, Shimura H, et al. Xanthogranulomatous cholecystitis versus gallbladder cancer: Clinical differentiating factors. Am Surg. 1997;63(4):367–371.
  • 8) Adachi Y, Iso Y, Moriyama M, et al. Increased serum CA 19-9 in patients with xanthogranulomatous cholecystitis. Hepatogastroenterology. 1998;45(19):77–80.
  • 9) L.-F.Zhang,C.-S.Hou, J.-Y.Liuet al., “Strategies for diagnosisof xanthogranulomatous cholecystitis masquerading as gallbladder cancer,” ChineseMedical Journal, vol. 125, no. 1, pp. 109–113, 2012.
  • 10) Krishnani N, Dhingra S, Kapoor S, Pandey R. (2007) Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases. Acta Cytol 51:37–41.
  • 11) Lee HS, Joo KR, Kim DH, Park NH, Jeong YK, Suh JH et al. (2003) A case of simultaneous xanthogranulomatous cholecystitis and carcinoma of thegallbladder. Korean J Intern Med 18:53–56.
  • 12) Yang T, Zhang B, Zhang J, Zhang Y, Jiang X, Wu M. (2007) Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases. Hepatobiliary Pancreat Dis Int 6:504–508.
  • 13) Kwon AH, Matsui Y, Uemura Y. Surgical Procedures and Histopathologic Findings for Patients with Xanthogranulomatous Cholecystitis. J Am Coll Surg. 2004;199:204–210.
  • 14) Guzman- Valdivia G: Xanthogranulomatous cholecystitis in laparoscopic surgery. J Gastrointest Surg 2005; Apr. 9 (4) : 494–497.
  • 15) Qasaimeh, Ghazi Raji, et al. "Xanthogranulomatous Cholecystitis in the Laparoscopic Era Is Still a Challenging Disease." Journal of Gastrointestinal Surgery 19.6 (2015): 1036-1042.
  • 16) Kwon A-H, Matsui Y, Uemura Y. (2004) Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis. J Am Coll Surg 199:204–210.
  • 17) Chang BJ, Kim SH, Park HY, Lim SW, Kim J, Lee KH et al. (2010) Distinguishing xanthogranulomatous cholecystitis from the wallthickening type of early-stage gallbladder cancer. Gut Liver 4:518–523.
  • 18) Krishna RP, Kumar A, Singh RK, Sikora S, Saxena R, Kapoor VK. (2008) Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: presentation and surgical management. J Gastrointest Surg 12:836–841
  • 19) Ueda J, Yoshıda H, Arıma Y, Mamada Y, Tanıaı N,Mıneta S, Yoshıoka M, Kawano Y, Naıto Z, Uchıda E.A case of xanthogranulomatous cholecystitis preoperativelydiagnosed with contrastenhanced ultrasonography.J Nihon Med Sch 2011; 78: 194-198.
  • 20) Sharma D, Babu R, Sood G, Kapoor G, Solankı RS, Thomas S.Xanthogranulomatous cholecystitis masquerading as malignancy with liver metastasis.ANZ J Surg 2009; 79: 946-947.
  • 21) Hale, Matthew David, et al. "Xanthogranulomatous cholecystitis: a European and global perspective." HPB 16.5 (2014): 448-458.
  • 22) Morera Ocón FJ, Ballestín Vicente J, Ripoll Orts F, Landete Molina F, García-Granero Ximénez M, Millán Tarín J et al. (2009) [Gallbladder cancer in a regional hospital]. Cir Esp 86:219–223.
  • 23) Choi SB, Han HJ, Kim CY, Kim WB, Song T-J, Suh SO et al. (2009) Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 33: 2657–2663.
  • 24) Yamamoto H, Hayakawa N, Kitagawa Y, Katohno Y, Sasaya T, Takara D et al. (2005) Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 12:391–398.
  • 25) Benbow EW, Taylor PM: Simultaneous xanthogranulomatous cholecystitis and primary adenocarcinoma of the gallbladder. Histopathology 1988; 12(6): 672–675.
  • 26) Rammohan, Ashwin, et al. "Xanthogranulomatous cholecystitis masquerading as gallbladder cancer: can it be diagnosed preoperatively?." Gastroenterology research and practice 2014 (2014).
  • 27) Hijioka S, Mekky MA, Bhatia V, Sawaki A, Mizuno N, Hara K et al. (2010) Can EUSguided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc 72:622–627.
  • 28) Heimbach JK, Sanchez W, Rosen CB, Gores GJ. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford). 2011;13:356–360.
  • 29) Sawada, Shigeaki, et al. "Expression of GLUT-1 and GLUT-3 in xanthogranulomatous cholecystitis induced a positive result on 18F-FDG PET: report of a case." International surgery 98.4 (2013): 372-378.
  • 30) Yu H, Yu TN, Caı XJ. Tumor biomarkers: help or mislead in the diagnosis of xanthogranulomatous cholecystitis?- analysis of serum CA 19-9, carcinoembryonic antigen, and CA 12-5. Chin Med J (Engl) 2013; 126: 3044-3047.
  • 31) Krishna RP, Kumar A, Singh RK, Sikora S, Saxena R, Kapoor VK. Xanthogranulomatous inflamantio stricture of extrahepatic biliary tract: Presentation and surgical management. J Gastrointest Surg. 2008;12:836–841.
  • 32) Srikanth G, Kumar A, Khare R, Siddappa L, Gupta A, Sikora SS, et al. Should Laparoscopic Cholecystectomy be performed in patients with thick-walled gallbladder? J Hepatobiliary Pancreat Surg. 2004;11:40–44.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Genel Cerrahi
Bölüm Makaleler
Yazarlar

Serhat Tokgöz

Proje Numarası -
Yayımlanma Tarihi 16 Ekim 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 71 Sayı: 1

Kaynak Göster

APA Tokgöz, S. (2018). An Analysis of Xanthogranulomatous Cholecystitis Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(1), 81-86.
AMA Tokgöz S. An Analysis of Xanthogranulomatous Cholecystitis Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2018;71(1):81-86.
Chicago Tokgöz, Serhat. “An Analysis of Xanthogranulomatous Cholecystitis Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, sy. 1 (Ekim 2018): 81-86.
EndNote Tokgöz S (01 Ekim 2018) An Analysis of Xanthogranulomatous Cholecystitis Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 1 81–86.
IEEE S. Tokgöz, “An Analysis of Xanthogranulomatous Cholecystitis Cases”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 1, ss. 81–86, 2018.
ISNAD Tokgöz, Serhat. “An Analysis of Xanthogranulomatous Cholecystitis Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/1 (Ekim 2018), 81-86.
JAMA Tokgöz S. An Analysis of Xanthogranulomatous Cholecystitis Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:81–86.
MLA Tokgöz, Serhat. “An Analysis of Xanthogranulomatous Cholecystitis Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 1, 2018, ss. 81-86.
Vancouver Tokgöz S. An Analysis of Xanthogranulomatous Cholecystitis Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(1):81-6.
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