ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Xanthogranuloma is a non-neoplastic presentation of chronic inflammation commonly seen in gallbladder, kidney and rarely seen in genital organs. Only one case has been reported in cervix. Here, we report a case of 60-year-old postmenopausal lady who presented with history of fever and purulent discharge per-vaginum. On speculum examination, cervix had an ulcer extending from 3 to 5 o'clock position. Uterus was bulky. On probing the ulcer, a 1-cm deep sinus was identified. Ultrasound showed enlarged uterus and fluid collection suggestive of pyometra. Pyometra was drained and cervical biopsy was taken from the ulcerated lesion; histopathology revealed granulomatous inflammation with predominantly xanthous cells suggestive of tuberculosis. High index of clinical suspicion needs to be maintained in abnormal cervix. It is a perplexing and rare entity for a clinician and also a diagnosis of exclusion; only histopathology can help for diagnosis. It mimics like malignancy and chronic infections.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Cervix Uteri , Diagnosis , Fever , Gallbladder , Genitalia , Inflammation , Kidney , Pyometra , Surgical Instruments , Tuberculosis , Ulcer , Ultrasonography , UterusABSTRACT
Xanthogranuloma is a non-neoplastic presentation of chronic inflammation commonly seen in gallbladder, kidney and rarely seen in genital organs. Only one case has been reported in cervix. Here, we report a case of 60-year-old postmenopausal lady who presented with history of fever and purulent discharge per-vaginum. On speculum examination, cervix had an ulcer extending from 3 to 5 o'clock position. Uterus was bulky. On probing the ulcer, a 1-cm deep sinus was identified. Ultrasound showed enlarged uterus and fluid collection suggestive of pyometra. Pyometra was drained and cervical biopsy was taken from the ulcerated lesion; histopathology revealed granulomatous inflammation with predominantly xanthous cells suggestive of tuberculosis. High index of clinical suspicion needs to be maintained in abnormal cervix. It is a perplexing and rare entity for a clinician and also a diagnosis of exclusion; only histopathology can help for diagnosis. It mimics like malignancy and chronic infections.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Cervix Uteri , Diagnosis , Fever , Gallbladder , Genitalia , Inflammation , Kidney , Pyometra , Surgical Instruments , Tuberculosis , Ulcer , Ultrasonography , UterusABSTRACT
Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.
Subject(s)
Humans , Middle Aged , Adenocarcinoma , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Inflammation , Magnetic Resonance Imaging , Pancreas , Pancreatic Neoplasms , Pancreatitis , TailABSTRACT
Objective: To review the demographic, clinical and histomorphological aspects of xanthogranulomatous inflammation (XGI) in different organs. Material and methods: All the cases diagnosed as XGI by histopathology from the specimens received in the department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India over the period of 10 years from January 2001 to December 2010 were included in the study. All the available data including age, sex, organ of involvement, association with stone etc. were collected and analyzed retrospectively. All the slides were reviewed. The results were recorded and ana-lyzed. Results: A total of 98 cases of XGI were diagnosed out of a total of 9755 specimens received, constituted by 5382 of gall bladder, 4298 of appendix, 41 of kidney and 24 of tube and tubo-ovarian mass making an overall incidence of 1%. The incidence of XGI in kidney was 12.19%, followed by 4.16% in tube and tubo-ovarian mass, 1.5% in gall bladder and 0.25% in appendix. Maximum number of cases were in the age group of 41-50 years with 33.67%. The female to male sex ratio was 2.5: 1. 90.2% cases in kidney and 86.6 % in gall bladder were associated with calculi. One case was associated with adenocarcinoma of gall bladder. Conclusion: Xanthogranulomatous inflammation which often mimics malignancy clinically and morphologically, is increasingly recognized in different anatomic locations. An accurate diagnosis will relieve the psychological panic of suspected malignancy and prevent the patient from aggressive treatment.
ABSTRACT
A mass formed around a cotton matrix left within the body is termed as gossypiboma. It is a rare complication of surgery and often occurs mainly after abdominal operations. The incidence of gossypiboma is underreported, due to legal implications of their detection. Furthermore, a correct diagnosis can be made only in one-third of cases. Clinical presentation is variable, depending on the location of the foreign body and on the type of inflammatory reaction. The recommended choice of treatment is excision, with the most important consideration given to prevention. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation, which is destructive to affected organs. To the best of our knowledge, we report the first case of gossypiboma associated with xanthogranulomatous inflammation. A gauze accidently left in the lateral neck after a neuro-surgical intervention was found during resection of mass-like lesion and xanthogranulomatous inflammation was diagnosed on histopathologic exam.
Subject(s)
Diagnosis , Foreign Bodies , Incidence , Inflammation , NeckABSTRACT
Xanthogranulomatous inflammation (XGI) is a rare benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages. This disease entity has been described in various organs but most commonly in the kidney and gallbladder. The occurrence of this disease in the lower gastrointestinal tract is extremely rare. Its clinical importance is that it can be misdiagnosed as an infiltrative cancer. In this case report, a 52-year-old male complained of right lower quadrant abdominal pain for a period of 3 months. Abdominal computed tomography revealed appendiceal mass and colonoscopy revealed multiple erythematous nodular lesions in the terminal ileum and appendiceal orifice, mimicking appendiceal cancer. Right hemicolectomy was done and the pathological specimen revealed XGI of the terminal ileum. To our knowledge, this is the first case of XGI in terminal ileum presenting as abdominal pain and the appendiceal mass on radiologic findings.
Subject(s)
Humans , Male , Abdominal Pain , Appendiceal Neoplasms , Colonoscopy , Gallbladder , Ileum , Inflammation , Kidney , Lower Gastrointestinal Tract , MacrophagesABSTRACT
Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.
Subject(s)
Aged , Female , Humans , Adenocarcinoma, Mucinous/diagnosis , Carcinoma in Situ/diagnosis , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Papillary/diagnosis , Diagnosis, Differential , Granuloma/complications , Magnetic Resonance Imaging , Pancreatic Neoplasms/diagnosis , Pancreaticoduodenectomy , Pancreatitis/complications , Tomography, X-Ray Computed , Xanthomatosis/complicationsABSTRACT
Xanthogranulomatous inflammation is a rare chronic inflammatory condition that is characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells). Although the precise pathogenesis of xanthogranulomatous inflammation is not well understood, various mechanisms have been proposed, including chronic recurrent infection, the presence of gallstones, immunologic disorders and defective lipid transport. This disease entity is well recognized in the kidney and gallbladder, yet involvement of the gastrointestinal tract is extremely rare and the involvement of both the stomach and colon has never been reported on. A coexisting malignancy rarely has been reported in a patient with xanthogranulomatous inflammation. This might present as an inflammatory mass-like lesion with infiltration to the surrounding tissues, and so this often mimics advanced cancer. Therefore, a surgical operation together with careful pathological evaluation is required for making the precise diagnosis. We herein report on a case of xanthogranulomatous inflammation that presented as a submucosal mass in the stomach which was a huge irregular mass involving transverse colon.
Subject(s)
Humans , Colon , Colon, Transverse , Gallbladder , Gallstones , Gastrointestinal Tract , Inflammation , Kidney , Macrophages , StomachABSTRACT
Xanthogranulomatous inflammation is a rare condition characterized by aggregation of foamy histiocytes, fibrosis and parenchymal destruction. A 53-year-old man presented suffering from dyspepsia. Endosonography revealed a submucosal lesion that was a 2.6 cm-sized hypoechoic mass. We could not differentiate the lesion as a benign or malignant mesenchymal tumor, particularly a gastrointestinal stromal tumor, necessitating a wedge resection. The stomach wall was focally thickened, measuring 1.0 cm in size. No definite mass was grossly evident. Microscopic examination revealed multiple foamy histiocytes and subserosal fibrosis. Xanthogranulomatous inflammation of the gastric wall was diagnosed.
Subject(s)
Humans , Middle Aged , Dyspepsia , Endosonography , Fibrosis , Gastrointestinal Stromal Tumors , Histiocytes , Inflammation , Liver Neoplasms , Mesenchymoma , Stomach , Stress, PsychologicalABSTRACT
Xanthogranulomatous inflammation is a chronic inflammatory condition characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells). This disease entity is well- recognized in the kidney and gallbladder. However, involvement of the colon is extremely rare. Radiologically, xanthogranulomatous inflammation could be misinterpreted as a locally invasive cancerous lesion. Indeed, coexisting malignancy has been reported in xanthogranulomatous inflammation. In this case report, a woman complained of fever and right lower quadrant abdominal pain for a period of 5 days. A huge mass lesion with severe pericolic infiltration was found on abdominal CT scan. Right hemicolectomy was performed along with removal of the adjacent soft tissue and right ovary and fallopian tube. Pathology examination demonstrated xanthogranulomatous inflammation coexisting with cecal cancer (T3N0M0).