Ooforosalpingitis xantogranulomatosa. Comunicación de caso

La inflamación xantogranulomatosa del tracto genital femenino es infrecuente y es aún más rara en las trompas de Falopio y ovarios. Se presenta un caso de ooforosalpingitis xantogranulomatosa en una paciente femenina de 45 años quien asistió a consulta por presentar dolor en fosa iliaca izquierda acompañado de fiebre. La exploración bimanual mostró útero ligeramente aumentado de tamaño con masa anexial izquierda firme, no dolorosa, adherida al útero y con limitada movilidad. La evaluación ecográfica transvaginal determinó tumoración ovárica izquierda, heterogénea con paredes gruesas e irregulares con múltiples septos y ecos internos sin visualizar el ovario. Durante la cirugía, se encontraron adherencias densas desde la masa hacia la pared lateral pélvica, fosa ovárica y asas intestinales. El útero estaba desplazado por tumoración anexial quística izquierda, de color blanco grisáceo y paredes gruesas que drenaba líquido purulento fétido. El diagnóstico definitivo fue ooforosalpingitis xantogranulomatosa. Esta condición es un proceso inflamatorio poco frecuente que plantea dilemas diagnósticos. Sus manifestaciones clínicas y características de estudios por imágenes pueden simular una neoplasia pélvica maligna, por lo que es necesario un alto índice de sospecha para su diagnóstico, como diagnóstico diferencial en pacientes con tumoraciones ováricas quísticas complejas. El examen histopatológico es el estándar de oro para el diagnóstico.

Xanthogranulomatous inflammation of the female genital tract is infrequent and is even rarer in fallopian tubes and ovaries. We present a case of xanthogranulomatous oophorosalpingitis in a 45-year-old female patient who consulted for left iliac fossa pain accompanied by fever. Bimanual examination revealed a slightly enlarged uterus with a firm, non-painful left adnexal mass, adherent to the uterus and with limited mobility. Transvaginal ultrasound evaluation showed a heterogeneous left ovarian tumor with thick and irregular walls, multiple septa and internal echoes without visualization of the ovary. During surgery, dense adhesions were found from the mass to the pelvic lateral wall, ovarian fossa, and bowel loops. The uterus was displaced by a thick-walled, grayish-white, cystic left adnexal tumor draining foul-smelling purulent fluid. The definitive diagnosis was xanthogranulomatous oophorosalpingitis. This condition is a rare inflammatory process that poses diagnostic dilemmas. Its clinical manifestations and imaging features may mimic a malignant pelvic neoplasm, so a high index of suspicion is necessary for its diagnosis, as a differential diagnosis in patients with complex cystic ovarian tumors. Histopathological examination is the gold standard for diagnosis.

Xanthogranulomatous Inflammation of the Aortic Aneurysm Wall after Endovascular Aortic Repair for Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA)．Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.

Xanthogranulomatous pyelonephritis in a pediatric patient / Pielonefrite xantogranulomatosa em paciente pediátrico

Abstract Introduction: Xanthogranulomatous pyelonephritis consists of a chronic infectious and inflammatory process of the renal parenchyma, a variant of chronic obstructive pyelonephritis. It is more prevalent in middle-aged adults, rare in pediatric patients, with less than 300 cases reported in children worldwide. Report: Preschooler, aged 2 years and 11 months, male, with 2 months of abdominal distention, increased temperature and intense pallor, associated with microcytic anemia refractory to the use of ferrous sulfate. 1 week before, he had a bulging in his left flank and a hard palpable mass there. Imaging exams (ultrasound and tomography) revealed an overall enlargement of the left kidney, destruction of the renal parenchyma and intense calyceal dilation, forming the "bear's paw" sign, with a staghorn calculus in the pelvis. He underwent treatment with antibiotic therapy and total nephrectomy, with a specimen sent for pathological examination. Discussion: a disease of uncertain incidence in the pediatric age group, xanthogranulomatous pyelonephritis is more prevalent in male children and affects mainly the left kidney, being frequently associated with the presence of stones. Clinically, it has nonspecific symptoms, the most common being abdominal distension and asthenia. Laboratory exams shows microcytic, leukocytosis, thrombocytosis and increased inflammation, pyuria, hematuria and proteinuria, in addition to bacterial growth in urine culture. The diagnosis is anatomopathological, but it can be hinted by contrasted CT scan, with the classical sign of the "bear's paw". Treatment may include nephrectomy and broad-spectrum antibiotic therapy.

Resumo Introdução: A pielonefrite xantogranulomatosa consiste em um processo infeccioso e inflamatório crônico do parênquima renal, variante da pielonefrite obstrutiva crônica. É mais prevalente em adultos na meia-idade, de ocorrência rara em pacientes pediátricos, com menos de 300 casos relatados em pediatria no mundo. Relato: Pré-escolar de 2 anos e 11 meses, do sexo masculino, com quadro de 2 meses de distensão e aumento da temperatura abdominal e palidez intensa, associado a anemia microcítica refratária ao uso de sulfato ferroso. Apresentava ainda, havia 1 semana da internação, abaulamento em região do flanco esquerdo e massa palpável, de consistência endurecida. Exames de imagem (ultrassonografia e tomografia) revelaram aumento global do rim esquerdo, destruição do parênquima renal e intensa dilatação calicial formando o sinal da "pata de urso", com presença de cálculo coraliforme em pelve. Submetido a tratamento com antibioticoterapia e nefrectomia total, com produto enviado para anatomopatológico. Discussão: Doença de incidência incerta na faixa pediátrica, a pielonefrite xantogranulomatosa é mais prevalente no sexo masculino na infância e acomete principalmente o rim esquerdo, estando frequentemente associada à presença de cálculos. Clinicamente apresenta-se como quadro arrastado de sintomas inespecíficos, sendo os mais comuns distensão abdominal e astenia. Laboratorialmente, apresenta-se com anemia microcítica, leucocitose, trombocitose e aumento de provas inflamatórias, piúria, hematúria e proteinúria, além de crescimento bacteriano em cultura de urina. O diagnóstico é anatomopatológico, porém pode ser sugerido pela tomografia computadorizada com contraste, que tem como sinal clássico a "pata de urso". O tratamento pode incluir nefrectomia e antibioticoterapia de amplo espectro.

Spontaneous Nephrocutaneous Fistula in Xanthogranulomatous Pyelonephritis — A Rare Complication

The formation of fistulous tract between the kidney and adjacent organs is not uncommon while cutaneous fistulization is a rarer occurrence. We present a case of Nephrocutaneous Fistula without prior history of surgery or interventional procedure. Our case involves long standing obstructive pyonephrosis secondary to obstructing calculus at the ureteropelvic junction which led to formation of a fistulous tract upto the skin surface. This patient had complaints of purulent discharge from the right flank region associated with fever spikes since the last 1 month. The cutaneous manifestation in specific location should raise the possibility of underlying renal pathology

Clinicopathological characteristics of 5 cases of adult orbital xanthogranulomatous disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To examine the clinicopathological characteristics of adult orbital xanthogranulomatous disease(AOXGD).<p> METHODS: From January 2015 to January 2021, the researchers collected postoperative pathological diagnoses cases of AOXGD from Xi'an People's Hospital(Xi'an Fourth Hospital), retrospectively analyzed clinical pathological data, and reviewed related literature. <p>RESULTS: A total of five AOXGD cases were collected, including three cases of adult-onset xanthogranuloma(AOX), one case of necrobiotic xanthogranuloma(NBX), and one case of Erdheim-Chester disease(ECD). The five patients were composed of middle-aged and elderly patients with local orbital lesions were treated. Microscopic examination revealed that the orbital skin and subcutaneous tissue had foam-like non-Langerhans histiocytes that exhibited diffused or nested infiltration. Immunohistochemistry revealed that the cells were positive for CD68, CD163, FXⅢa, lysozyme, negative for S100, CD1a, Langerin, HMB-45, MDM2. One ECD patient had orbital lesions as the first symptom and exhibited a combination of retroperitoneal lesions, right atrium pseudotumor, and long bones, heart, kidney lesions. The diagnosis of AOXGD depends on clinical manifestations and pathological features. The treatment was based on subtypes and clinical manifestations to select corresponding strategies, which mainly include the administration of glucocorticoids, immunosuppressants, and surgical treatment. <p>CONCLUSION: AOXGD is relatively rare in clinical practice. AOXGD can manifest as a local orbital disease or an orbital disease combined with a systemic disease. In the clinical and pathological work of ophthalmology, the understanding and identification of this group of diseases should be strengthened, and correct diagnosis and standard treatment should be promoted.

Fistula reno-apendicular como presentación inusual de pielonefritis xantogranulomatosa: reporte de caso / Reno-appendicular fistulus as an unusual presentation of xanthogranulomatous pyelonephritis: a case report

Resumen La fístula uro-entérica es una comunicación patológica entre la vía urinaria y digestiva. El compromiso del apéndice es infrecuente y son pocos los casos de fístulas reno-apendiculares en la literatura. Se presenta el caso de un paciente con clínica de fiebre, dolor lumbar e hidronefrosis derecha severa secundaria a cálculo coraliforme en la tomografía de vías urinarias. Manejado inicialmente con antibióticos y nefrostomía bajo fluoroscopia, posteriormente suspendida por paso de contraste al intestino. Se realizó una tomografía contrastada que reportó fístula del riñón al intestino. Se llevó a nefrectomía y se encontró fistula hacía el apéndice, por lo cual se realizó apendicectomía concomitante con mejoría clínica evidente. La patología reportó pielonefritis xantogranulomatosa y apendicitis secundaria. La fístula reno-apendicular posee una clínica inespecífica, la tomografía contrastada es una herramienta diagnóstica y la mayoría se detectan como un hallazgo intraoperatorio. El tratamiento usualmente es quirúrgico, con nefrectomía y reparación del segmento intestinal. MÉD. UIS.2021;34(3): 79-84.

Abstract Uro-enteric fistula is a pathological communication between the urinary and digestive tract. Compromise of the appendix is infrequent and few cases of reno-appendicular fistulas have been described in the literature. The case of patient with symptoms of fever, low back pain and severe right hydronephrosis secondary to staghorn calculus on urinary tract tomography is presented. Initially managed with antibiotics and nephrostomy under fluoroscopy, subsequently suspended by passing contrast to the intestine. A contrasted tomography was performed which reported a fistula from the kidney to the intestine. A nephrectomy was carried out and a fistula was found to the appendix, for which a concomitant appendectomy was performed with evident clinical improvement. The pathology reported xanthogranulomatous pyelonephritis and secondary appendicitis. Reno-appendicular fistula has nonspecific symptoms, contrasted tomography is a diagnostic tool and most are detected as an intraoperative finding. Treatment is usually surgical, with nephrectomy and intestinal segment repair. MÉD.UIS.2021;34(3): 79-84.

Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of large number of lipid laden macrophages with an admixture of neutrophils, lymphocytes, plasma cells and multinucleated giant cells. It is misdiagnosed as ovarian tumour that leads to extensive surgery including hysterectomy. In this report we describe a case of Xanthogranulomatous salpingo-oophoritis along with review of literature.

Xanthogranulomatous salpingo-oophoritis mimicking an ovarian malignancy: a clinical dilemma

Background: Xanthogranulomatoussalpingo-oophoritis is an uncommon form of chronic inflammation in the genitourinary tract. Its symptoms and radiological findings mimic ovarian malignancy. Aim of this study was to evaluate the clinicopathological pattern of xanthogranulomatous salphingo oophoritis.Methods: This study was conducted in the department of pathology, Government Medical College, Srinagar. It was a retrospective study done over a period of 5 years, November 2014 to November 2019.Results: The study was done to evaluate the clinicopathological pattern of 6 cases of rare entity xantogranulomatous salphingo oophoritis diagnosed at a tertiary care hospital. All patients, presented with pain abdomen. All patients were operated due to radiological suspicion of ovarian malignancy. Histopathological examination proved the lesion as xanthogranulomatous salphingo oophoritis.Conclusions: Xanthogranulomatoussalpingo-oophoritis is a rare condition that is often mistaken for ovarian malignancy clinically and radiologically. Oophorectomy is the recommended treatment but most women are “over treated” with staging laparotomies and hysterectomies that render them infertile.

Xanthomatous hypophysitis: A rare case report with review of literature

Hypophysitis is classified into primary and secondary. Xanthomatous hypophysitis is one of the rare types of primary hypophysitis. A 55-year-old female presented with headache, vomiting, and blurring of vision. She also had endocrine dysfunction in the form of low serum T3, T4, and low cortisol levels. MRI scan showed a sellar expansile lesion suggestive of pituitary macroadenoma. Microscopy showed pituitary tissue replaced by inflammatory infiltrate made up of foamy histiocytes arranged in sheets along with lymphoplasmacytic infiltrate. Interspersed areas of fibrosis, hyalinization, few congested and sclerosed blood vessels were seen. Compressed residual pituitary tissue was identified at the periphery. Xanthomatous hypophysitis is a rare entity which can mimic as pituitary adenoma both clinically and radiologically. Accurate diagnosis at an early stage with postsurgical steroid therapy may help to prevent permanent pituitary damage.

The value of conventional ultrasound combining with contrast-enhanced ultrasound in the diagnosis of xanthogranulomatous cholecystitis / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in improving the diagnosis ability for xanthogranulomatous cholecystitis ( XGC ) and wall-thickening gallbladder cancer ( GBC) . Methods Forth-three patients with XGCs and 31 patients with wall-thickening GBCs proved by pathology were enrolled in this study ,the features on conventional ultrasound and CEUS were recorded ,and the preliminary diagnosis before and after CEUS were given by doctors . Results Significant differences were found in continuous gallbladder inner wall and arterial blood supplement on conventional ultrasound , 58 .1％ (25/43) had continuous inner wall and 34 .9％ (15/43) had arterial blood flow in XGCs compared to 19 .4％ (6/31) and 100％ in GBCs . On CEUS ,72 .1％ (31/43) demonstrated continuous gallbladder inner wall and 48 .8％ (21/43) had hypoechoic nodules in the wall in XGCs compared to 16 .1％ (5/31) and 19 .4％ (6/31) in GBCs ,respectively ( P <0 .05) . No significant difference was found in intra-calcification , infiltration to adjacent organs ,gallbladder stones and fast-in and fast-out enhanced pattern( P >0 .05) . The area under ROC curve was improved from 0 .701 to 0 .899 after combining with CEUS ( P < 0 .05 ) . Conclusions Conventional ultrasound combining with CEUS could help acquiring more effective ultrasonic information and may improve the differential diagnosis ability of XGCs and GBCs .

Xanthogranulomatous pyelonephritis: an analysis of 41 cases / 中华泌尿外科杂志

Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP).Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed.There were 17 male cases and 24 female cases,aged from 23 to 78 years,with an average age of 57 years.All were unilateral lesions,including 19 cases on the left and 22 cases on the right.Disease duration ranged from 1 week to 12 years,with an average of 3.5 years.The clinical manifestations showed that 7 cases with gross hematuria (17.1％),16 cases with palpable flank or abdominal mass (39.0％),36 cases with flank pain (87.8％),26 cases with acute or intermittent fever (63.4％) and 17 cases with weight loss (41.5％).Laboratory findings showed that 28 cases with leukocytosis (68.3％),24 cases with anemia (58.5％),27 cases with pyuria (65.9％),positive urine culture 19/34 (55.9％),positive urine lipid-laden macrophages 3/14(21.4％),and 20 cases with rapid erythrocyte sedimentation rate (48.8％).Imaging examination:among 35 patients who received CT examination,25 were diagnosed as XGP,mainly presenting diffuse changes in the kidney with enlarged renal shadow,accompanied by diffusive distribution of multiple low-density lesions.There was no obvious enhancement in the low-density lesions on enhanced scan,accompanied by thickening of renal fascia,adhesion to psoas major muscle or involvement of surrounding tissues and organs.According to the imaging results,there were 33 cases of diffuse type and 8 cases of localized type in this group.Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP.Results All patients were treated with surgical procedure.33 patients with diffuse type were performed nephrectomy.6 of the 8 patients with localized type underwent partial nephrectomy successfully,and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries.All postoperative pathologies suggested xanthogranulomatous pyelonephritis.Patients were followed up for 9 months to 10 years postoperatively,with an average of 4.5 years.All patients had no recurrence.Conclusions The clinical manifestations of XGP are lack of specificity.Diagnosis is difficult and depends on pathology.According to imaging examination,lesions can be divided into diffuse type and localized type.Nephrectomy and partial nephrectomy were performed respectively.

XANTHOGRANULOMATOUS CHOLECYSTITIS: A DIAGNOSTIC DILEMMA

@#Xanthogranulomatous cholecystitis is a rare histopathological finding and accounts for 1.3% to 5.2% of cases. It closely resembles gallbladder cancer because of its extensive inflammation and involvement of the surrounding organs. We are reporting a case where it presents as an extensive inflammatory mass mimicking gallbladder cancer.

Surgical treatment of xanthogranulomatous cholecystitis: a report of 56 patients / 中华肝胆外科杂志

Objective To study the surgical treatment of xanthogranulomatous cholecystitis (XGC).Methods We retrospectively analyzed the clinical data of 56 patients with XGC who underwent surgical treatment at the Zhejiang Provincial People's Hospital from May 2010 to May 2017.Results The diagnosis of XGC was confirmed by histopathology.On preoperative examination of the 56 patients,42 patients had various degrees of increase in the CA19.9 levels,41 patients (73.2％) had thickened gallbladder walls with continuous mucosal linings on ultrasonography,CT,or MRI,and 18 patients (32.1％) had thickening of gallbladder walls with low density nodules.Gallbladder stones were present in 51 patients (91.1％) and 4 patients (7.2％) presented with Mirizzi syndrome.The 41 patients (73.2％) who were diagnosed as XGC before operation under laparoscopic surgery and 7 patients (17.1％) were converted to open surgery.The remaining 15 patients (26.8％) underwent open operation directly because of uncertainty in the diagnosis.All the patients had frozen section during operation.The postoperative pathological results included 21 localizedtype (37.5％) and 35 diffuse type (62.5％) of XGC.All 56 patients had no long-term complications on followed-up for 0.5～ 6 years.Conclusions XGC is a special kind of chronic cholecystitis.There is difficulty in differentiating from gallbladder cancer before surgery.The diagnosis of XGC mainly depends on ultrasonography,CT or MRI.Cholecystectomy is the treatment for XGC.Laparoscopic surgery is the first line treatment for XGC.

Endoscopic Resection of Xanthogranulomatous Gastritis Presenting as a Subepithelial Tumor: A Case Report

Xanthogranulomatous gastritis (XGG) presenting as a subepithelial tumor (SET) is a very rare entity. We report a case of SET-like XGG diagnosed and treated with endoscopic resection. A 55-year-old female patient was initially referred with a 1.5-cm SET located at the anterior wall of the middle antrum. Endoscopic ultrasound examination revealed submucosal invasion without any perigastric lymph node enlargement. Endoscopic resection was performed for an accurate diagnosis and treatment, and the lesion was diagnosed histopathologically as XGG. At the 18-month follow-up after endoscopic resection, there was no evidence of XGG recurrence. SET-like XGG is very rare and the diagnosis is a preoperative challenge. However, inflammatory tumors should be considered in the differential diagnosis of SET

IgG4-related Ophthalmic Disease Associated with Adult Xanthogranulomatous Disease

PURPOSE: To report a case of immunoglobulin G4 (IgG4)-related ophthalmic disease associated with adult xanthogranulomatous disease. CASE SUMMARY: A 38-year-old male with a history of cholecystectomy visited our clinic for bilateral periorbital swelling. Histopathology of the orbital biopsy showed diffuse infiltration of foamy histiocytes with Touton giant cells and lymphoid follicles, with a diagnosis of adult-onset xanthogranuloma. After excisional biopsy, he was treated with azathioprine and prednisolone. Four years after treatment, he again visited the clinic due to bilateral, yellowish eyelid masses. Serological examinations were all nonspecific findings, except for elevation of IgG and IgG4 levels. Magnetic resonance imaging showed bilateral symmetric soft tissue enlargement with slightly heterogeneous T1/T2 isosignal intensity, with contrast enhancement at the superolateral aspect of extraconal spaces. Excisional biopsy and blepharoplasty were performed. Immunohistochemical sections showed that the IgG4+/IgG plasma cell ratio was 10–20% and the IgG4 plasma cell count was 22/high power field (HPF). His past sections of 2013 from the pathology department were again stained and showed that the IgG4+/IgG plasma cell ratio was 40–50% and the IgG4 plasma cell count was 59/HPF. Thus, he was definitely diagnosed with IgG4-related ophthalmic disease. CONCLUSIONS: If there is recurrent eyelid swelling, IgG4-related ophthalmic disease should be considered as a differential diagnosis. And the patient with adult xanthogranulomatous disease can be diagnosed with IgG4-related ophthalmic disease.

Differential diagnosis and surgery for gallbladder carcinoma and xanthogranulomatous cholecystitis / 中华肝胆外科杂志

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

Clinical advances in adult orbital xanthogranulomatous disease / 国际眼科杂志(Guoji Yanke Zazhi)

·Adult orbital xanthogranulomatous disease is a group of rare orbital and ocular adnexal disorders, which is classified as class II non - Langerhans histiocytic proliferations. This disease can be classified into 4 subtypes based mainly on systemic involvement: adult-onset xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease and adult-onset asthma and periocular xanthogranuloma. Diagnosis depends on its characteristic clinical manifestations and pathologic features. Therapeutic approaches are derived from anecdotal evidences, which include corticosteroid, immunosuppressive agent, surgical debulking and chemotherapy. The management of this disease varies with different subtypes, as well as associated systemic presentations. This review summarizes advances of etiopathogenesis, clinical features, diagnosis and treatment.

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: an analysis of 42 patients / 中华肝胆外科杂志

Objective To study the clinical features of xanthogranulomatous cholecystitis (XGC),and to analyze the difficulties in the differential diagnosis of XGC with gallbladder carcinoma.Methods The clinical data of 42 patients who were diagnosed preoperatively as gallbladder cancer in our hospital from 2008 to 2016 were retrospectively analyzed.Results Of the 42 patients,upper abdominal CT scans were carried out in 38 patients,and MRI examination in 4 patients.Imaging findings showed unclear boundaries between the liver and the gallbladder in 37 patients,and unclear boundaries between the gallbladder and the adjacent tissues in 16 patients.In 11 patients,the regional lymph nodes were enlarged.22 patients had gallstones.All the 42 patients had gallbladder wall thickness of ≥3 mm.In 27 patients there were diffuse thickenings of the gallbladder wall,while in 15 patients there were only local thickenings.In 35 patients,inhomogeneous enhancement of the gallbladder wall was shown on CT enhancement scanning,and in 11 patients,there were low attenuation nodules in the gallbladder wall.All the 42 patients underwent surgical treatment.During surgery,dissection of the gallbladder triangle was difficult because of dense adhesion of the gallbladder with the surrounding tissues.In 32 patients,the gallbladder was adherent to the omentum,in 16 patients to the duodenum,in 12 patients to the colon,and in 8 patients to the stomach.In 30 patients,intraoperative frozen sections were carried out.Two patients were diagnosed to have early gallbladder cancer (T1a GBC).In 12 patients who did not receive frozen section during operation,6 patients were subsequently diagnosed to have XGC and 6 patients to have gallbladder cancer.The types of surgical treatment given to these patients were according to the intraoperative diagnosis or frozen sections results.After surgery,one patient each developed surgical site infection in the total cholecystectomy group as well as in the partial cholecystectomy group.In addition,one patient had bile duct injury and another patient had duodenal injury in the total cholecystectomy group.There was one patient who had residual biliary stone in the partial cholecystectomy group.The difference in the postoperative complication rates between the two groups was not significant (P ＞ 0.05).Conclusions It is difficult to differentiate XGC from gallbladder cancer based on clinical and imaging findings.The final diagnosis still depends on histopathological examination.

Xanthogranulomatous pyelonephritis and renal tubulopapillary adenomas: A rare coexistence.

Xanthogranulomatous pyelonephritis is an uncommon inflammatory condition accounting for 1% of chronic pyelonephritis cases. Clinically and radiologically it mimics other renal space occupying lesions. Hence, correct preoperative diagnosis is not possible in all cases and nephrectomy is done in most patients. Renal tubulopapillary adenomas are benign epithelial lesions of kidney found to be associated with papillary renal cell carcinoma, acquired renal cystic disease, long term hemodialysis, arteriosclerotic renal vascular disease, etc. Here, we report two cases of Xanthogranulomatous pyelonephritis associated with the rare finding of renal tubulopapillary adenomas.