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Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 84-86

Eosinophilic cholecystitis associated with xanthogranulomatous cholecystitis: A rare entity


1 Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut, India
2 Department of Psychiatry, Subharti Medical College, Meerut, India
3 Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, India
4 Department of Surgery, Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
5 Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India

Date of Web Publication29-Dec-2014

Correspondence Address:
Monika Rathi
228/16, Saket Colony, North Civil Lines, Muzaffarnagar - 251 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-4220.148012

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  Abstract 

Eosinophilic cholecystitis is a rare form of cholecystitis. It is believed that eosinophilic cholecystitis is associated with eosinophilic cystitis, parasitic infections, eosinophilic gastroenteritis, and drugs. We report the case of a 23-year-old female who presented with the clinical complaints of pain in epigastrium and burning sensation for 1 month. Ultrasound showed the presence of cholelithiasis. Open cholecystectomy was done. Histopathological report showed the presence of eosinophilic cholecystitis and xanthogranulomatous cholecystitis. Both these entities are rare and their association has not been reported in the literature so far. We report this case because of the rarity of its association.

Keywords: Cholelithiasis, eosinophilic cholecystitis, xanthogranulomatous cholecystitis


How to cite this article:
Rathi M, Singh P, Budania SK, Mittra P, Khalid M, Mittal A. Eosinophilic cholecystitis associated with xanthogranulomatous cholecystitis: A rare entity. Int J Adv Med Health Res 2014;1:84-6

How to cite this URL:
Rathi M, Singh P, Budania SK, Mittra P, Khalid M, Mittal A. Eosinophilic cholecystitis associated with xanthogranulomatous cholecystitis: A rare entity. Int J Adv Med Health Res [serial online] 2014 [cited 2018 May 27];1:84-6. Available from: http://www.ijamhrjournal.org/text.asp?2014/1/2/84/148012


  Introduction Top


Both eosinophilic cholecystitis and xanthogranulomatous cholecystitis are rare entities. [1],[2],[3] The association between the two entities has not been reported. We report the case of a 23-year-old female who was diagnosed as eosinophilic cholecystitis with associated xanthogranulomatous cholecystitis, due to its rarity.


  Case report Top


A 23-year-old female presented with pain in epigastrium with burning sensation for 1 month. All hematological investigations were normal. Ultrasound whole abdomen showed two echogenic foci of gall bladder stones, with the largest measuring approximately 1.8 cm in the gall bladder lumen [Figure 1]. Clinico-radiological diagnosis of cholelithiasis was done preoperatively. Initially, laparoscopic cholecystectomy was attempted, but it was converted to open cholecystectomy due to the presence of thickened gall bladder wall and the excised gall bladder was sent for histopathology. Outer surface of the gall bladder was distorted and the cut surface showed thickened gall bladder wall with maximum gall bladder thickness of 1.9 cm [Figure 2]a, b. Histological examination showed sheets of lipofuschin-laden macrophages, suggestive of xanthogranulomatous inflammation near the fundus. The sections taken from the body and neck showed intense eosinophilic infiltrate with eosinophils as the predominant inflammatory cells. So, a diagnosis of eosiniphilic cholecystitis with xanthogranulomatous cholecystitis and cholelithiasis was made [Figure 3]a-d. Bile sample was also cultured and was found sterile.
Figure 1: Ultrasound showing gall bladder stone

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Figure 2: (a) Outer surface of eosinophilc cholecystitis with xanthogranulomatous change. (b) Cut section of gall bladder showing thickened gall bladder wall

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Figure 3: (a) Eosinophilic cholecystitis with hyperplastic mucosal folds and Rokitansky-Aschoff sinuses (HE 100×). (b) Eosinophilic cholecystitis with numerous bilobed eosinophils (HE 400×). (c) Eosinophilic cholecystitis with xanthogranulomatous change (HE 100×). (d) Eosinophilic cholecystitis with xanthogranulomatous change (HE 400×)

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  Discussion Top


Eosinophilic cholecystitis comprises 0.25-6.4% of all cholecystitis. [1],[2] It is three times more likely to be acalculous than the usual cholecystitis. [4] Eosinophilic cholecystitis shows massive outpouring of eosinophils. [5] The diagnosis is based on classical symptoms of cholecystitis with the presence of >90% eosinophilic infiltration within the gall bladder. [6] However, the general rule is that the eosinophils are out of proportion of the other inflammatory cells. [4] Cholecystectomy appears to be the adequate treatment for eosinophilic cholecystitis. [7] Eosinophilic cholecystitis has been reported alone or in combination with eosinophilic gastroenteritis, eosinophilia-myalgia syndrome, idiopathic hypereosinophilic syndrome, eosinophilic cystitis, parasitic infestations (Clonorchis sinensis and hydatid cyst disease), and antibiotics (erythromycin and cephalosporins). [8],[9],[10] To the best of our knowledge, association between eosinophilic cholecystitis and xanthogranulomatous cholecystitis has never been reported. The incidence of xanthogranulomatous cholecystitis was 6% of all cholecystectomies, and the age range has been reported between 25 and 62 years with a mean age of 40.3 years. A female:Male ratio is 1.6:1. Chronic right upper quadrant pain was the most common clinical presentation. 84.6% cases show thickening of gall bladder wall. [3] Histologically, xanthogranulomatous cholecystitis is the presence of nodular collections of macrophages with lightly pigmented lipofuschin granules in the cytoplasm in the wall of gall bladder. [4] Cholecystectomy remains the treatment of choice. Occasional co-existence of gall bladder carcinoma is seen with xanthogranulomatous cholecystitis. [3] Thus, we conclude that both these rare entities can also exist together and in these cases, there are higher chances of conversion of laparoscopic cholecystectomy to open cholecystectomy.


  Acknowledgment Top


The authors acknowledge Engineer Ayush for his technical help.

 
  References Top

1.
Albot G, Olivier C, Libaude H. Les cholecystitis eosinophils. Presse Med 1949;57:558-9.  Back to cited text no. 1
    
2.
Sahu S, Srivastava P, Chauhan N, Kishore S, Bahl DV. Eosinophilic cholecystitis: A case report. The Internet Journal of Surgery 2007:9:1.  Back to cited text no. 2
    
3.
Jetley S, Rana S, Khan RN, Jairajpuri ZS. Xanthogranulomatous cholecystitis - A diagnostic challenge. J Indian Med Assoc 2012;110:833-7.  Back to cited text no. 3
    
4.
Hruban RH, Argani P, Ali SZ. The pancreas and extrahepatic biliary system. In: Silverberg SG, DeLellis RA, Frable WJ, LiVolsi VA, Wick MR, editors. Silverberg's Principles and Practice of Surgical Pathology and Cytopathology. London: Churchill Livingstone; 2005. p. 1577.  Back to cited text no. 4
    
5.
Rosai J. Gall bladder and extrahepatic bile ducts. In: Rosai J, editor. Rosai and Ackerman's Surgical Pathology. 10 th ed. USA: Elsevier Mosby; 2011. p. 988.  Back to cited text no. 5
    
6.
Shakov R, Simoni G, Villacin A, Baddoura W. Eosinophilic cholecystitis, with a review of the literature. Ann Clin Lab Sci 2007;37:182-5.  Back to cited text no. 6
    
7.
Sánchez-Pobre P, López-Ríos Moreno F, Colina F, Yela C, Manzano M, Rodríguez S, et al. Eosinophilic cholecystitis: An infrequent cause of cholecystectomy. Gastroenterol Hepatol 1997;20:21-3.  Back to cited text no. 7
    
8.
Felman RH, Sutherland DB, Conklin JL, Mitros FA. Eosinophilic cholecystitis, appendiceal inflammation, pericarditis, and cephalosporin-associated eosinophilia. Dig Dis Sci 1994;39:418-22.   Back to cited text no. 8
    
9.
Malik KA. Eosinophilic cholecystitis: An infrequent cause of cholecystectomy. Pak J Med Sci 2010;26:724-5.  Back to cited text no. 9
    
10.
Mallat F, Hmida W, Mestiri S, Ziadi S, Sriha B, Mokni M, et al. Eosinophilic cystitis with eosinophilic cholecystitis: A rare association. Case Rep Urol 2013;2013:146020.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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