Xanthogranulomatous Cholecystitis (Histology from Imaging)

Male patient, 65 years, presenting with vague right hypochondrial pain. On USG showing marked diffuse thickening of gall bladder wall, measuring up to 20mm maximum thickness. Increased vascularity is also noted within the thickened GB wall.

GB lumen showed a large 20.5mm x 18.6mm calculus, with associated luminal sludge.

Above image showing marked thickening of GB wall on left and ill-defined interface of thickened GB wall with hepatic parenchyma (segment V).

A radiologist in his / her report if can suggest the histopathological diagnosis, I believe that would be an ideal situation. Its never easy even with history, clinical diagnosis, lab tests. The ill-defined margins of thickened GB wall and hepatic parenchyma, was suspicious of infiltration. CA-19-9 value was not available at the time of scan. CECT Abdomen was also performed without much significant added information. There were no significant lymphadenopathy / other focal liver lesions / ascites. Close differentials of XGC and Ca.GB were given. Patient underwent surgery, in which GB wall seen adherent to liver and a partial resection of involved parenchyma was also done. HPR came as Xanthogranulomatous Cholecystitis.

Diagnosis Please Series : December 2016 : Q1

4 year old child with upper abdominal pain. Serum Amylase >2000.

TSTCs - Too Small To Characterize

TSTCs or ' Too Small To Characterize' Lesions

• Hepatic lesions 1.5 cm in diameter or smaller are frequently difficult to characterize at CT and are often reported as being “too small to characterize” (TSTC) by the interpreting radiologist.
• Most of the TSTCs are hypodense.
• In a patient without a known malignancy, TSTCs should be considered benign.
• Single TSTC in patient with malignancy are considered benign.
• If >1 TSTCs in a Oncology patient, they are mostly benign, especially if they are homogenous and sharply defined.
• Of cancers Ca. Breast TSTCs are more likely to be a metastatic lesion, than others (Ca Breast > Colorectal > Lymphoma).
• TSTCs are followed up, to look for change in size.

References
1. Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology 2005.
2. Liver Incidentalomas http://www.radiologyassistant.nl/en/p45a5e818c709d