Daily Pearl(s):
Xanthogranulomatous Cholecystitis (XGC)
XGC is a rare destructive inflammatory disease of the gallbladder that is a variant of chronic cholecystitis.
It is characterized by a massive inflammatory reaction that often forms a tumor-like mass, making it a well-known mimic of gallbladder carcinoma.
A non-visualized gallbladder replaced by an inflammatory mass containing a large stone is commonly seen on imaging.
The pathophysiology is thought to involve chronic obstruction (typically by a large gallstone), leading to increased intraluminal pressure and rupture of the Rokitansky-Aschoff sinuses. This allows bile to extravasate into the gallbladder wall, inciting a significant inflammatory response dominated by lipid-laden macrophages (xanthoma cells), lymphocytes, and fibrosis, which can even invade adjacent structures like the liver, making it look like a malignancy.
Source: CPS - April 9, 2026 VMR with Rabih & Siva - chest pain and vomiting