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Case of the Month



Xanthogranulomatous Cholecystitis

A 54 year old women with no significant past medical history presents with severe right upper abdominal pain which radiates to the right scapula.  Ultrasound showed the presence of several gallstones.  Cholecystectomy yielded a 7.0 cm specimen with a markedly thickened wall and hyperplastic mucosal lining, focally significant for cholesterolosis.  Multiple cholesterol stones and stone fragments were present.  Histologic sections showed a proliferation of spindled to plasmacytoid cells with foamy cytoplasm.  Luminal macrophages and scattered cholesterol clefts were present.  Most of the luminal epithelium was eroded.  The intact epithelium was without atypia.  Immunoperoxidase stains showed that the lesional cells were positive for CD68 and negative for S100, HMB45, pancytokeratin, Cam5.2, CK34betaE12, SMA, desmin, CD45, and CD138.  A diagnosis of xanthogranulomatous cholecystitis was rendered.