20例黄色肉芽肿性胆囊炎患者影像学和组织病理学特点分析

目的 探讨黄色肉芽肿性胆囊炎(XGC)患者影像学和组织病理学特征。方法 回顾性分析我院经手术后组织病理学检查证实的20例XGC患者CT、MRI和组织病理学特点。结果 CT检查显示,90.0%患者胆囊增大,100.0%胆囊增厚,其中局限性增厚为35.0%,弥漫性增厚为65.0%。20.0%增强扫描在动脉期发现囊内强化结节,75.0%在静脉期发现多发低密度结节。75.0%见胆囊结石,75.0%肝脏与胆囊间隙不清,40.0%增强扫描发现胆囊黏膜线连续,60.0%胆囊黏膜线中断;在12例检查了MRI的患者中,91.7%胆囊增大,100.0%胆囊增厚,其中局限性增厚为50.0%,弥漫性增厚为50.0%,且呈“夹心饼干征”。100.0%在增厚的胆囊壁内发现多发结节状异常信号,100.0%在静脉期强化囊壁内发现低信号结节,100.0%见胆囊结石,91.7%肝脏与胆囊间隙不清,58.3%胆囊黏膜线连续,41.7%胆囊黏膜线中断。25.0%胆囊黏膜剥脱呈网格状改变;大多数病例胆囊组织呈纤维组织增生伴炎性细胞浸润,增厚囊壁内见大量泡沫样细胞聚集形成肉芽肿状结构。结论 XGC患者存在较为典型的影像学特征,了解这些特点对术前做出正确的诊断和处理非常重要。

Imaging features of 20 xanthogranulomatous cholecystitis: An analysis of 20 cases

Objective The aim of this study was to summarize imaging features of xanthogranulomatous cholecystitis (XGC) and its histopathological manifestations. Methods The clinical material of 20 patients with XGC proven by surgery and pathology was retrospectively analyzed, and the imaging incluing CT and MRI, and histopathological features were summarized. Results The CT scan showed that the gallbladder was enlarged in 90.0% of the patients, 100.0% gall bladder thickened, including 35.0% localized and 65.0% diffuse thickening. 20.0% of the patients presented with enhanced intra-gall bladder nodules at the arterial phase and 75.0% with multiple low-density nodules at the venous phase. All patient had cholecystolithiasis. 75.0% of the patients demonstrated unclear gaps between liver and gallbladder. 40.0% of the patients presented with continuous, while 60.0% with interrupted enhancement of gallbladder mucosa line; the MRI indicated the gallbladder enlargement was found in 91.7% of patients, and 100% with the gall bladder wall thickened, among which the localized thickened in 50.0% and the diffuse thickened in 50.0%, presenting with "sandwich biscuit sign"; 100.0% of patients showed multiple abnormal nodular signals in thickened gallbladder wall, and 100.0% with enhanced intra-cystic nodules with low signal at enhanced venous phase. All patients had cholecystolithiasis. The gaps between liver and gallbladder were unclear in 91.7% of patients. 58.3% of patients presented with continuous, while 41.7% with interrupted enhancement of gallbladder mucosa line. 25.0% had reticular changes at mucosal stripping. The histopathological examination showed that fibrosis withinflammatory cell infiltration in gall bladder tissues, and granulomatous formation with abundant foam-like cell gathering at the bladder walls. Conclusion The patients with XGC have a unique imaging features, which might help making a correct pre-operational diagnosis and management.