Chronic gallbladder wall thickening: Is it always malignancy?

Gallbladder wall thickening, associated with features like perforation, fistula formation and invasion of adjacent organs, is often assumed to be malignant. Xanthogranulomatous cholecystitis (XGC) causes gallbladder wall thickening with similar aggressive features and closely mimics gallbladder carcinoma clinically, radiologically and surgically. Differentiating between these two is crucial for management as misdiagnosis of gallbladder cancer can lead to unnecessary radical surgery. We report a case of chronic gallbladder wall thickening, initially suspected to be malignant, but subsequently diagnosed as XGC.