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Perera A, Rus M, Thom M, Critchley G. Xanthogranulomatous osteomyelitis of the cervical spine. Br J Neurosurg 2024; 38:1158-1162. [PMID: 35695311 DOI: 10.1080/02688697.2022.2086967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Xanthogranulomatous Osteomyelitis is a rare form of chronic inflammation described in a handful of cases in the reported literature involving the long bones of the axial skeleton. To the authors knowledge it has not been reported in the spinal column. CASE We report a case of a 65 year old female presenting with features of metastatic cord compression and an expansile lesion affecting the 5th -7th cervical vertebrae. She underwent vertebrectomy, insertion of an expandable cage and plating to good effect. A histological diagnosis of Xanthogranulomatous Osteomyelitis was made. CONCLUSIONS We report what the authors believe to be the first case in the literature of xanthogranulomatous osteomyelitis affecting the spine. In this case the patient was managed with a vertebrectomy without the need for antibiotics.
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Affiliation(s)
- Andrea Perera
- Department of Neurosurgery Royal, Sussex County Hospital, Brighton, UK
| | - Mircea Rus
- Department of Neurosurgery Royal, Sussex County Hospital, Brighton, UK
| | - Maria Thom
- Department of Neuropathology National Hospital for Neurology and Neurosurgery UCLH, London, UK
| | - Giles Critchley
- Department of Neurosurgery Royal, Sussex County Hospital, Brighton, UK
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2
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Tanioka N, Kuwahara M, Sakai T, Nokubo Y, Hiroi M, Akimori T. Xanthogranulomatous appendicitis presenting asymptomatically 3 years after surgery for hilar cholangiocarcinoma: A case report. Int J Surg Case Rep 2024; 120:109800. [PMID: 38823225 PMCID: PMC11169530 DOI: 10.1016/j.ijscr.2024.109800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Xanthogranulomatous appendicitis (XGA) is a rare condition involving chronic inflammation of the appendix that is often difficult to distinguish from malignancy using imaging because of the formation of a heterogeneous mass with indistinct borders. Herein, we present a case of XGA with unusual clinical manifestations. PRESENTATION OF CASE A 78-year-old female patient underwent radical resection of hilar cholangiocarcinoma with extended right hepatic lobectomy and biliary reconstruction. Three years postoperatively, she presented with an irregular mass in the right lateral pelvis, which was observed on computed tomography. The patient had not experienced recent clinical symptoms and did not present with abdominal tenderness. Routine blood tests did not indicate an increased inflammatory response; however, carcinoembryonic antigen levels continued to increase. Although disseminated recurrence of hilar cholangiocarcinoma and appendiceal carcinoma were suspected, XGA was diagnosed via laparoscopic appendectomy. DISCUSSION XGA generally presents with symptoms of acute or chronic appendicitis, and is diagnosed incidentally during surgery. Hilar cholangiocarcinoma has a high recurrence rate, even after radical resection, and disseminated recurrence usually requires chemotherapy. In the present case, XGA was not suspected preoperatively because of the lack of physical symptoms and increased levels of tumor markers during follow-up for hilar cholangiocarcinoma. There have been no reports of XGA with such a confusing clinical course, thus confirming the difficulty in preoperatively diagnosing XGA. CONCLUSION The preoperative diagnosis of XGA is difficult to differentiate from malignancy because of its clinical and imaging findings. We diagnosed the patient with XGA using laparoscopic surgery.
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan.
| | - Michio Kuwahara
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan
| | - Takashi Sakai
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan.
| | - Yuzuko Nokubo
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan
| | - Makoto Hiroi
- Department of Pathology, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan
| | - Toyokazu Akimori
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-city, Kochi 788-0785, Japan
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3
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Choi K, Yoon Y, Hong R, Kim HL, Chung JH, Shin BC. Sternoclavicular xanthogranulomatous osteomyelitis in a patient after kidney transplantation: a case report. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:150-153. [PMID: 38725186 PMCID: PMC11228384 DOI: 10.4285/ctr.24.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 06/29/2024]
Abstract
Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.
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Affiliation(s)
- Kiyoung Choi
- Suwan Happiness Geriatric Hospital, Gwangju, Korea
| | - Youngmin Yoon
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Ran Hong
- Department of Pathology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Lee Kim
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Jong Hoon Chung
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Byung Chul Shin
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
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Nagata K, Nakamura K, Iida T, Iwasaki J, Ito R, Asai S, Ishihara M, Hata T, Itami A, Kyogoku T. A case of progressive xanthogranulomatous pancreatitis with splenic abscess. Clin J Gastroenterol 2024; 17:580-586. [PMID: 38457070 DOI: 10.1007/s12328-024-01930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings.
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Affiliation(s)
- Keiji Nagata
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Kojiro Nakamura
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan.
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Taku Iida
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Junji Iwasaki
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Ryo Ito
- Department of Gastroenterology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Satsuki Asai
- Department of Diagnostic Pathology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Misa Ishihara
- Department of Diagnostic Pathology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Toshiyuki Hata
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Atsushi Itami
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Takahisa Kyogoku
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
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5
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Ambar N, Mans C, Gasper DJ. Antemortem Diagnosis and Successful Long-term Management of Disseminated Intracoelomic Xanthogranulomatous Disease in an Eclectus Parrot ( Eclectus roratus). J Avian Med Surg 2024; 37:330-338. [PMID: 38363165 DOI: 10.1647/2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A 12-year-old male eclectus parrot (Eclectus roratus) was referred for evaluation of coelomic distention. Computed tomography and blood work revealed coelomic effusion with free coelomic mineral-attenuating material and elevations in the bile acids and aspartate aminotransferase activity, respectively. Coelomic effusion was consistent with macrophagic inflammation with abundant intracellular lipids. Initial treatment with meloxicam resulted in minimal patient improvement. Disseminated xanthogranulomatous inflammation was suspected based on imaging and diagnostic laboratory results, which were consistent with those previously reported. Biopsy samples of liver tissue and intracoelomic masses confirmed this diagnosis. Treatment was initiated with prednisolone 1 mg/kg/d for 6 months, followed by 0.5 mg/kg/d for 3 months. Clinical improvement was assessed based on owner evaluation, plasma bile acid concentrations, and repeated computed tomographic scans. After 2 months of treatment, the owner reported improved behavior and appetite; this persisted throughout treatment and when the bird was reexamined 17 months following the cessation of steroid therapy. Bile acid concentrations were normal 10 months after the prednisolone therapy was discontinued. Diagnostic imaging showed minimal coelomic effusion 10 months after the last prednisolone dose was administered, with improved ventilation of the air sacs and static to improved dystrophic mineral foci. This report describes the antemortem diagnosis and treatment of disseminated coelomic xanthogranulomatous disease in a psittacine species, with an observed measurable therapeutic response.
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Affiliation(s)
- Neta Ambar
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA
| | - Christoph Mans
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA,
| | - David J Gasper
- School of Veterinary Medicine, University of Wisconsin, Madison, Madison, WI 53706, USA
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Wang W, Korah M, Bessoff KE, Shen J, Forrester JD. Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report. World J Gastrointest Surg 2023; 15:488-494. [PMID: 37032803 PMCID: PMC10080595 DOI: 10.4240/wjgs.v15.i3.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/15/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Xanthogranulomatous inflammation (XGI) is an uncommon process involving an accumulation of inflammatory cells, commonly lipid-laden macrophages. XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract. We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum, in which the patient had an initial diagnostic laparoscopy, continued to have symptoms, then proceeded to have the definitive treatment. To our knowledge, this is the first report of XGI associated with a prior small bowel anastomosis.
CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers. She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior. Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis. She underwent a laparotomy, resection of the prior anastomosis and re-anastomosis, with final histopathological examination findings consistent with mural XGI.
CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.
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Affiliation(s)
- William Wang
- Department of Biology, Stanford University, Stanford, CA 94305, United States
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States
| | - Maria Korah
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
| | - Kovi E Bessoff
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
| | - Jeanne Shen
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Palo Alto, CA 94304, United States
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
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7
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Skoczek AC, Fernandez DL. Xanthogranulomatous appendicitis diagnosed on routine PET scan: a case report. J Surg Case Rep 2022; 2022:rjac482. [PMID: 36324762 PMCID: PMC9613120 DOI: 10.1093/jscr/rjac482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
Xanthogranulomatous appendicitis (XGA) is a rare process affecting the appendix vermiformis. Due to the atypical presentation of XGA, it is most commonly diagnosed post operatively on surgical pathology and is associated with interval appendectomies. Here, we describe a rare case of XGA diagnosed on pathology after acute appendicitis was found on routine Positron emission tomography scan for a minimally symptomatic patient with stage IV adenocarcinoma of the lung. Further prospective studies are required to evaluate the atypical presentation of XGA and the use of interval appendectomies following acute appendicitis diagnosis.
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Affiliation(s)
- Alexandra C Skoczek
- Correspondence address. Edward Via College of Osteopathic Medicine – Auburn, Auburn, AL 36830, USA. Tel: (815) 735-7259; E-mail:
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8
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Xanthogranuloma of the Sellar Region: A Comprehensive Review of Neuroimaging in a Rare Inflammatory Entity. J Pers Med 2022; 12:jpm12060943. [PMID: 35743728 PMCID: PMC9225214 DOI: 10.3390/jpm12060943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
Xanthogranuloma of the sellar region is a rare chronic inflammatory lesion resulting from secondary hemorrhage, inflammation, infarction, and necrosis of an existing Rathke’s cleft cyst, craniopharyngioma, or pituitary adenoma. Sellar xanthogranulomas are challenging to differentiate from other cystic lesions preoperatively due to the lack of characteristic imaging features. We performed a literature overview of the clinical and paraclinical features, treatment options, and long-term outcomes of patients with sellar xanthogranuloma, focusing on the preoperative radiological diagnosis. The hyperintense signal in both T1- and T2-weighted sequences, cystic or partially cystic morphology, ovoid shape, sellar epicenter, intra- and suprasellar location, intratumoral calcifications, linear rim contrast enhancement, and the absence of cavernous sinus invasion suggest xanthogranuloma in the preoperative differential diagnosis. An endoscopic endonasal gross total resection without radiotherapy is the preferred first-line treatment. Given the low rate of recurrence rate and low chance of endocrinological recovery, a mass reduction with decompression of the optic apparatus may represent an appropriate surgical goal. Identifying the xanthogranulomas’ mutational profile could complement histopathological diagnosis and give insight into their histo-pathogenesis. A better preoperative neuroimagistic diagnosis of sellar xanthogranulomas and differentiation from lesions with a poorer prognosis, such as craniopharyngioma, would result in an optimal personalized surgical approach.
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9
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Nakashima K, Demura Y, Tada T, Akai M, Ishizuka T. Xanthomatous Pleuritis Associated With Pancreaticopleural Fistula. J Bronchology Interv Pulmonol 2022; 29:155-157. [PMID: 34907976 PMCID: PMC8942709 DOI: 10.1097/lbr.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Koki Nakashima
- Depertment of Respiratory Medicine, Japanese Red Cross Fukui Hospital
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui-ken, Japan
| | - Yoshiki Demura
- Depertment of Respiratory Medicine, Japanese Red Cross Fukui Hospital
| | - Toshihiko Tada
- Depertment of Respiratory Medicine, Japanese Red Cross Fukui Hospital
| | - Masaya Akai
- Depertment of Respiratory Medicine, Japanese Red Cross Fukui Hospital
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui-ken, Japan
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10
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Xanthogranulomatus inflammatory lesion mimicker of malignancy: A clinicopathological study from rural India. North Clin Istanb 2021; 8:485-492. [PMID: 34909587 PMCID: PMC8630717 DOI: 10.14744/nci.2021.04317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Xanthogranulomatus inflammation is an uncommon variant of chronic inflammation and a well-established pathological entity involving various organs and systems. It may be associated with infection and obstruction, defective lipid transport, immunological disturbances, and often confused as a malignant neoplasm. The confirmative diagnosis is made on histopathology. METHODS This is a retrospective study conducted from January 2008 to April 2020 on histopathologically diagnosed xanthogranulomatus lesions. All the relevant available data regarding age, sex, and organ involvement were collected from histopathology lab records. The macroscopic and microscopic evaluation of cases was also done. This study was aimed to determine the significance of histopathology in the diagnosis of xanthogranulomatus lesions, revealing pathological changes, and clinicopathological correlation. RESULTS In the current study, there were 93 cases of xanthogranulomatus inflammatory lesion. Gall bladder was frequently involved 70 (75.27%), followed by 5 (5.37%) kidney, gastrointestinal Tract 6 (3 [3.23%] cases in colon and 3 [3.23%] in appendix, respectively), and others. The maximum number of cases was in the age group of 31-40 years with 24 (25.80%) cases. The female to male sex ratio was 2.3:1. CONCLUSION Awareness and knowledge of xanthogranulomatus inflammatory lesion is significant to the pathologist and surgeon to prevent extensive surgery. This lesion often mimics as malignancy and confirmatory diagnosis is made on histopathology. Thus, every excised specimen must be examined histopathologically to diagnose and rule out differential.
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11
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Donovan TA, Garner MM, Phalen D, Reavill D, Monette S, Le Roux AB, Hanson M, Chen S, Brown C, Echeverri C, Quesenberry K. Disseminated coelomic xanthogranulomatosis in eclectus parrots ( Eclectus roratus) and budgerigars ( Melopsittacus undulatus). Vet Pathol 2021; 59:143-151. [PMID: 34794345 DOI: 10.1177/03009858211045931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Xanthogranulomatosis is an inflammatory lesion characterized by lipid-containing macrophages, extracellular lipid, hemorrhage, and necrosis. We describe disseminated intracoelomic xanthogranulomatosis in 5 eclectus parrots (Eclectus roratus) and 2 budgerigars (Melopsittacus undulatus). Postmortem, clinicopathologic, and historical case material was reviewed. Ages ranged from 3 to 24 years; there were 5 males and 2 females. Table food was included in the diet of 3/5 cases, and animal products were included in 2/3 cases. Common clinicopathologic abnormalities included leukocytosis (4/5 cases) and elevated concentrations of bile acids (3/4 cases) and cholesterol within 6 months prior to death (2/4 cases). At postmortem examination, all 7 birds had grossly visible, irregular, soft, tan to yellow, amorphous plaques distributed on the surfaces of the viscera and body wall. Histologic evaluation and oil red O stain revealed xanthogranulomatous inflammation with phagocytized and extracellular lipid, necrosis, cholesterol clefts, fibrosis, and mineralization. Infectious agents were not identified with special stains in all cases. Concurrent hepatobiliary disease was present in 6/7 cases, and 6/7 had lipid accumulation within the parenchyma of various visceral organs. Five cases had atherosclerosis of great vessels. We describe a unique form of disseminated coelomic xanthogranulomatosis in 2 psittacine species. This condition should be recognized as a differential diagnosis in cases of disseminated coelomic mass formation and coelomic distension in psittacine birds, particularly in eclectus parrots and budgerigars.
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Affiliation(s)
| | | | - David Phalen
- University of Sydney, Camden, New South Wales, Australia
| | | | - Sebastien Monette
- Memorial Sloane Kettering Cancer Center, New York, NY, USA.,The Rockefeller University, New York, NY, USA.,Weill Cornell Medicine, New York, NY, USA
| | | | | | - Sue Chen
- Gulf Coast Veterinary Specialists, Houston, TX, USA
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Zahid IG, Kummarapurugu S, Alrefai S. Xanthogranulomatous Breast Mass: An Unusual Presentation. Cureus 2021; 13:e17973. [PMID: 34660155 PMCID: PMC8516024 DOI: 10.7759/cureus.17973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Xanthogranulomatous inflammatory reactions are benign inflammatory processes characterized by aggregating lipid-laden foamy macrophages. Although cases have been reported in different organ systems, these rare reactions predominantly occur in the kidney and gallbladder. We present a 92-year-old female who noticed a palpable, tender mass in the lower inner quadrant of her right breast with no skin changes. She was referred to surgery by her primary care physician on suspicion of malignancy and further evaluation. Ultrasound-guided biopsy, ordered by the primary care provider, revealed a suspicious high-grade malignant neoplasm of uncertain origin. Pathological findings include the presence of an unusual population of malignant epithelioid cells with a striking xanthogranulomatous reaction, along with numerous Touton-like histiocytes. These findings are comparable in morphology to a recently reported xanthogranulomatous epithelial tumor. Given the lack of history of breast carcinoma in this patient as well as the lack of immunohistochemical studies suggesting breast carcinoma, treatment involved continuing standard of care for an unusual high-grade sarcoma via lumpectomy. A positron emission tomography (PET) scan was ordered to ensure there was no spread or alternate origins of the cancer tissue. This case report brings to light the findings of a probable xanthogranulomatous tumor in breast tissue, an exceptionally rare phenomenon in breast cancer, especially in the elderly population. Due to the rarity of xanthogranulomatous tumors in the breast, prognosis and standardized treatment have yet to be established.
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Affiliation(s)
- Ibtesam G Zahid
- General Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | | | - Sameer Alrefai
- General Surgery, Sentara Halifax Regional Hospital, South Boston, USA
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13
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Imokawa T, Ito K, Takemura N, Inagaki F, Mihara F, Kokudo N. Xanthogranulomatous Pancreatitis Accompanied by Xanthogranulomatous Cholecystitis: A Case Report and Literature Review. Pancreas 2021; 50:1037-1041. [PMID: 34643610 DOI: 10.1097/mpa.0000000000001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Xanthogranulomatous pancreatitis (XGP) is extremely rare, with only 31 cases reported in the English literature to date. We reviewed previously reported 17 articles about XGP and report an additional case of XGP. This is the first case of XGP with xanthogranulomatous cholecystitis accompanied by intraductal papillary mucinous carcinoma (IPMC) in an 80-year-old woman. She was referred to our hospital with jaundice and general malaise and was found to have a cystic mass at the pancreatic head and a solid mass at the pancreatic tail, with dilation of both the main pancreatic duct and biliary tract noted on computed tomography. Diagnosis of IPMC at the pancreatic head with neuroendocrine tumor at the pancreatic tail was made, and the patient underwent subtotal stomach-preserving pancreatoduodenectomy with enucleation of the mass at the tail. Pathological examination revealed IPMC with xanthogranulomatous changes around the IPMC and at the pancreatic tail and gallbladder. Xanthogranulomatous pancreatitis could be induced by inflammatory reaction due to obstruction of the pancreatic duct and biliary tract by mucin produced in the IPMC. It is sometimes difficult to preoperatively differentiate XGP from malignant pancreatic tumors, such as pancreatic carcinoma or neuroendocrine tumor, using imaging studies.
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Affiliation(s)
- Tomoki Imokawa
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Ito S, Takahashi Y, Yamada T, Kawai Y, Ohira K. Xanthogranulomatous appendicitis with elevated tumor marker misdiagnosed as cecal cancer: a case report. J Surg Case Rep 2021; 2021:rjab274. [PMID: 34345400 PMCID: PMC8326000 DOI: 10.1093/jscr/rjab274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Xanthogranulomatous inflammation is an uncommon chronic inflammatory disease that develops most often in the kidneys and gallbladder. However, xanthogranulomatous appendicitis 45eXA is rare. Herein, we present a case of XA, with an elevated tumor marker, misdiagnosed as cecal cancer. A 76-year-old woman was referred to our hospital. Carbohydrate antigen 19–9 (CA 19–9) levels were elevated. By computed tomography and magnetic resonance imaging, we diagnosed as suspected cecal cancer and performed laparoscopic-assisted ileocecal resection. The pathological diagnosis was XA. Her CA19–9 level decreased to within normal limits. XA is a condition that results from an unusual healing pattern of appendicitis. However, the underlying mechanisms are still unclear. This is the first case of XA with elevated CA 19–9 levels. In this case, XA may have had the potential for malignancy. Our case report can aid in the understanding of these rare cases and, as a result, improve their prognosis.
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Affiliation(s)
- Shunichi Ito
- Department of Surgery, Tama-Hokubu Medical Center, Tokyo, Japan
| | | | - Takuji Yamada
- Department of Surgery, Tama-Hokubu Medical Center, Tokyo, Japan
| | - Yosuke Kawai
- Department of Surgery, Tama-Hokubu Medical Center, Tokyo, Japan
| | - Kei Ohira
- Department of Surgery, Tama-Hokubu Medical Center, Tokyo, Japan
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Joseph E, Abraham R, Koshy S, John JK. A Rare Variant of Meningioma: Case Report and Review of Literature. Asian J Neurosurg 2021; 16:387-390. [PMID: 34268171 PMCID: PMC8244685 DOI: 10.4103/ajns.ajns_381_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022] Open
Abstract
Meningioma is a morphologically heterogeneous tumour arising from meningothelial cells that has been classified by the World Health Organization into 15 different histological types and graded into three types groups (Grade I, II, and III) based on the biological behavior. Metaplastic meningioma is a rare subtype of meningioma characterized by focal or widespread mesenchymal differentiation in the form of bone, cartilage, fat, or xanthomatous tissue elements. Xanthomatous meningioma is a subclass of metaplastic meningioma which is exceedingly rare. Only a few cases have been reported in the literature. Here, we report the case of a 44-year-old man, who presented with left sided weakness and was diagnosed as a case of xanthomatous meningioma.
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Affiliation(s)
- Elizabeth Joseph
- Department of Pathology, Believers Church Medical College, Thiruvalla, Kerala, India
| | - Rojin Abraham
- Department of Neurosurgery, Believers Church Medical College, Thiruvalla, Kerala, India
| | - Sujin Koshy
- Department of Neurology, Believers Church Medical College, Thiruvalla, Kerala, India
| | - John K John
- Department of Neurology, Believers Church Medical College, Thiruvalla, Kerala, India
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Bateman M, Kaphle U, Palomino J, Falk N, Kheir F. 54-Year-Old Man With Cough, Chest Pain, and Dyspnea on Exertion. Chest 2021; 158:e299-e303. [PMID: 33280773 DOI: 10.1016/j.chest.2020.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/20/2020] [Indexed: 10/22/2022] Open
Abstract
CASE PRESENTATION A 54-year-old man presented with 6 months' history of dry cough and dyspnea on exertion. He also reported intermittent joint pain and orthopnea. He denied fevers, chills, and rashes. His medical history was significant for rheumatoid arthritis, for which he was taking 20 mg of prednisone daily. He had not been receiving adalimumab or methotrexate for several months. He never smoked and drank alcohol occasionally. Family history was significant for rheumatoid arthritis.
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Affiliation(s)
- Marjorie Bateman
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Upendra Kaphle
- Division of Pulmonary and Critical Care, Kaiser Permanente Roseville and Sacramento Medical Center, Roseville, CA
| | - Jaime Palomino
- Division of Pulmonary, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Healthcare System, New Orleans, LA
| | - Nadja Falk
- Division of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.
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17
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Akbulut S, Demyati K, Koc C, Tuncer A, Sahin E, Ozcan M, Samdanci E. Xanthogranulomatous appendicitis: A comprehensive literature review. World J Gastrointest Surg 2021; 13:76-86. [PMID: 33552395 PMCID: PMC7830076 DOI: 10.4240/wjgs.v13.i1.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts.
AIM To review the medical literature on xanthogranulomatous appendicitis (XGA).
METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were “appendix vermiformis,” “appendectomy,” “acute appendicitis,” and “XGA.” The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study.
RESULTS A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy.
CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Khaled Demyati
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, An-Najah National University, Nablus, 44839, Palestine
| | - Cemalettin Koc
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emrah Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Mehmet Ozcan
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emine Samdanci
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Corless K, Samy A, Kamil A, Hogan AM. Benign cyst with xanthogranulomatous inflammation involving the transverse colon and the common iliac artery. J Surg Case Rep 2020; 2020:rjaa295. [PMID: 32963757 PMCID: PMC7490217 DOI: 10.1093/jscr/rjaa295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Xanthogranulomatous inflammation (XGI) is a rare process. Colonic XGI is extremely rare. We present a case report of XGI arising within an intra-abdominal cyst involving the transverse colon. A 28-year-old man presented with abdominal discomfort. He underwent a computed tomography abdomen–pelvis, which found three subcutaneous collections and a large cystic intra-abdominal structure. The decision was made for resection. Intraoperatively, the cyst originated from the pelvis and was adherent to the surrounding tissues. Histology from the lesion revealed XGI extending into the surrounding tissue. XGI is a rare inflammatory condition. Clinically, it can be difficult to distinguish XGI from an infiltrative malignancy. Therefore, it is usually necessary to obtain a pathological diagnosis of XGI. This case describes an atypical cystic lesion with XGI involving the transverse colon. Although rare, it should be considered in the potential differential diagnosis of an infective or malignant mesenteric cyst.
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Affiliation(s)
- Kevin Corless
- Department of Colorectal Surgery, University Hospital Galway, H91 YR71 Galway, Republic of Ireland
| | - Amir Samy
- Department of Colorectal Surgery, University Hospital Galway, H91 YR71 Galway, Republic of Ireland
| | - Ahmed Kamil
- Department of Colorectal Surgery, University Hospital Galway, H91 YR71 Galway, Republic of Ireland
| | - Aisling Maria Hogan
- Department of Colorectal Surgery, University Hospital Galway, H91 YR71 Galway, Republic of Ireland
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Jayanth KS, Balamurugan S, Sureshkumar S, Anandhi A, Sree Rekha J, Abdulbasith KM, Rajesh BS, Tajudeen M. Xanthogranulomatous adrenalitis masquerading as a functioning adrenocortical malignancy: a case report. TUMORI JOURNAL 2020; 106:NP84-NP88. [PMID: 32830993 DOI: 10.1177/0300891620949656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Xanthogranulomatous adrenalitis (XA) is a rare chronic inflammatory disease of the adrenal glands and resembles adrenal neoplasm in clinical and radiologic characteristics. There is no report on XA presenting as a functioning adrenal mass in the literature. We present a case of XA mimicking a functioning adrenocortical carcinoma. CASE REPORT A 52-year-old man presented with right flank pain, fever, vomiting, and loss of appetite for 2 weeks. He had signs of dehydration and elevated blood glucose level. Ultrasonography revealed a right adrenal mass. Contrast-enhanced computed tomography showed lobulated and necrotic mass replacing the right suprarenal gland and encasing the right renal vein, adjacent inferior vena cava, psoas, and diaphragm. There was loss of fat planes with liver and upper pole of the right kidney. Biochemical evaluation indicated increased serum and urine cortisol levels. As a sequel to hypercortisolism-induced hyperglycemia, he developed spontaneous chest wall abscess and bilateral sudden vision loss due to vitreous hemorrhages. Pus and blood culture grew methicillin-sensitive Staphylococcus aureus. Adrenal suppressant ketoconazole was administered for better glycemic control. With a diagnosis of locally advanced adrenocortical malignancy, right radical adreno-nephrectomy was performed, and cut section revealed a pus collection of around 100 mL. Histopathology examination showed xanthogranulomatous inflammation involving adrenal gland, Gerota's fascia, psoas, and lymph nodes. Postoperatively, the patient recovered satisfactorily with favorable glycemic control. CONCLUSION XA can mimic adrenal neoplasms both clinically and radiologically and is associated with staphylococcal infection. It warrants surgical excision and culture-based antibiotics and is mostly diagnosed on postoperative histopathology.
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Affiliation(s)
- Kalkunte Sriram Jayanth
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Balamurugan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Amaranathan Anandhi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - J Sree Rekha
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K M Abdulbasith
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - B S Rajesh
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Muhamed Tajudeen
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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20
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Hanson ME, Donovan TA, Quesenberry K, Dewey A, Brown C, Chen S, Le Roux AB. Imaging features of disseminated xanthogranulomatous inflammation in eclectus parrots (Eclectus roratus). Vet Radiol Ultrasound 2020; 61:409-416. [PMID: 32436257 DOI: 10.1111/vru.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/05/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
Xanthogranulomatous disease is a rare condition, which can be caused by infection, inflammation, hemorrhage, immunologic disease, or inherited lysosomal disorders. It is characterized by non-intracellular lipid and cholesterol deposits among an inflammatory infiltrate of vacuolated macrophages and giant cells. The diagnosis of xanthogranulomatous disease is challenging, with nonspecific imaging findings often misinterpreted as aggressive neoplastic processes in humans. In this retrospective case series study, we describe the diagnostic imaging characteristics of a disseminated xanthogranulomatous condition identified in five eclectus parrots (Eclectus roratus). Decreased serosal detail and celomic distension were present in all three birds radiographed, with multifocal variably sized celomic mineralization (3/3 birds), and extracelomic mineralized masses (1/3 birds). Celomic effusion with foci of celomic mineralization and hepatomegaly were identified in all birds (3/3) imaged with ultrasound. Finally, a mineralized mural ventricular mass was present in one of three patients imaged with CT, multifocal celomic mineralization with moderate to severe celomic effusion in two of three patients, diffuse severe proventricular and intestinal dilation in all three patients, and atherosclerosis of the major arterial trunks in all three patients. Veterinary radiologists should be aware of this inflammatory condition in birds, especially in eclectus parrots, and should be able to recognize the imaging features of xanthogranulomatous inflammation.
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Affiliation(s)
| | - Taryn A Donovan
- Department of Anatomic Pathology, Animal Medical Center, New York, New York
| | | | - Amanda Dewey
- Department of Avian and Exotic Medicine, Animal Medical Center, New York, New York
| | - Cindy Brown
- Department of Avian and Exotic Medicine, Animal Medical Center, New York, New York
| | - Sue Chen
- Department of Avian and Exotic Medicine, Gulf Coast Veterinary Specialists, Houston, Texas
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21
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Singhal S, Shekher C. Xanthogranulomatous osteomyelitis. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_72_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pathak S, Gautam R, Pc P, Bagtharia P, Sharma A. A Rare Case Report on Xanthogranulomatous Osteomyelitis of Hip Mimicking Tuberculosis and Review of Literature. Cureus 2019; 11:e5921. [PMID: 31788379 PMCID: PMC6857822 DOI: 10.7759/cureus.5921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory process characterized by the presence of a large number of lipid-containing macrophages with lymphocytes and plasma cells. We present a case of XO of the hip in a 50-year-old woman with pain in the left hip for 28 months. The patient had a history of taking anti-tuberculosis chemotherapy for five months. Laboratory data revealed an increased erythrocyte sedimentation rate and C-reactive protein (CRP) level. Plain radiographs showed the destruction of the femoral head with arthritis and subluxation. Magnetic resonance imaging (MRI) was suggestive of tubercular infection of the left hip and a benign lesion in the left ilium. The histopathologic examination of the specimen demonstrated the presence of dead bone surrounded by lymph-plasma cells, foamy cells, and histocytes, which was consistent with XO, and culture was positive for Staphylococcus aureus infection. The patient was successfully treated with resection arthroplasty and antibiotics. It is important for the surgeons to keep XO in the list of differentials in cases with lytic lesions of bone and assessment should include microbiological culture along with the biopsy.
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Affiliation(s)
- Subodh Pathak
- Orthopedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Ambala, IND
| | - Rakesh Gautam
- Orthopedics, Maharishi Markandeshwar University, Ambala, IND
| | - Prince Pc
- Orthopedics, Maharishi Markandeshwar University, Ambala, IND
| | | | - Aryan Sharma
- Orthopedics, Maharishi Markandeshwar University, Ambala, IND
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Abstract
Background: Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory process that is histologically characterized by the presence of foamy macrophages, histiocytes, and plasma cells. Radiologic and gross examinations can mimic malignancy, so definitive diagnosis should be made by histopathologic evaluation. Case Report: A 15-year-old male presented with pain in the proximal right leg for 2 weeks prior to admission. The patient had a history of leg trauma 3 years prior that was responsive to as-needed analgesics. Laboratory data revealed increased erythrocyte sedimentation rate and C-reactive protein. X-ray of the right tibia showed a periosteal reaction and bulging of bone with a questionable destruction of the cortex. Magnetic resonance imaging demonstrated an expansile bony lesion in the proximal metaphysis of the tibia. Histopathologic examination showed the bone trabecula surrounded by chronic inflammatory cells and a fragment of dead bone surrounded by histiocytes, foamy macrophages, and plasma cells. The pathologist confirmed the diagnosis of XO. Wound culture proved moderate growth of Staphylococcus aureus, and treatment with cefazolin and cephalexin was successful. Conclusion: The patient was not treated with the routine therapy used in previously reported cases (curettage), suggesting that antibiotic therapy should be considered before employing surgical interventions for XO.
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24
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Iype GR, Kalipatnapu S, Masih D, Varghese G. Not all colonic growths are malignant. BMJ Case Rep 2019; 12:12/7/e229515. [PMID: 31337625 DOI: 10.1136/bcr-2019-229515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 34-year-old woman who was diagnosed to have adenocarcinoma of the caecum based on the clinical, radiological, histopathological and intraoperative findings. However, postoperative histopathology showed only features of xanthogranulomatous inflammation without any evidence of malignancy. This benign chronic inflammatory condition could present as a histological surprise. It is important for both surgeons and pathologists alike to be aware of this.
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Affiliation(s)
- Geethu Rachel Iype
- Division of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sasank Kalipatnapu
- Division of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dipti Masih
- Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gigi Varghese
- Division of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Kwon JH, Kim JH, Kim SY, Byun JH, Kim HJ, Hong SM, Lee MG, Lee SS. Imaging and clinical features of xanthogranulomatous pancreatitis: an analysis of 10 cases at a single institution. Abdom Radiol (NY) 2018; 43:3349-3356. [PMID: 29725744 DOI: 10.1007/s00261-018-1630-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to investigate the imaging and clinical features of xanthogranulomatous pancreatitis (XGP). METHODS This retrospective series study included 10 patients with pathology-proven XGP. Two radiologists reviewed the computed tomography (CT) and magnetic resonance imaging (MRI) in consensus to determine the morphological features of XGP. The lesion enhancement pattern on dynamic contrast-enhanced scans and the MR signal intensity were also evaluated. Clinical data including symptoms, underlying pancreatic disease, and laboratory findings were reviewed. RESULTS Two XGP cases were of a solid type; six were of cystic type, and two were mixed type. XGP usually showed a lobulated contour (90%) and heterogeneous enhancement (100%), with lesion size varying from 2 to 11 cm. Perilesional infiltration was common (90%), but pancreatic duct dilatation was less frequent (30%). Cystic type XGP mostly had an irregular thick wall (83%). On dynamic contrast-enhanced CT/MRI, XGP enhanced progressively from arterial to portal or delayed phases. Lesions appeared hypointense on T1-weighted images (89%) and hyperintense on T2-weighted images (100%). All lesions appeared hyperintense on diffusion-weighted images, with the majority (78%) showing diffusion restriction on apparent diffusion coefficient maps. The patients often had abdominal pain (80%) and underlying pancreatic disease (80%), but mostly had normal or clinically insignificant laboratory findings. CONCLUSIONS XGP typically manifests as a clinically silent lobulated heterogeneous mass, with a progressive enhancement pattern and/or irregular thick wall, and diffusion restriction on CT/MRI. Awareness of the imaging and clinical features of XGP may help differentiate it from pancreatic neoplasms, thereby reducing unnecessary surgery.
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Affiliation(s)
- Ji Hye Kwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seung-Mo Hong
- Department of Diagnostic Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
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Wong YP, Tan GC, Kumar R. Xanthomatous meningioma: A metaplastic or degenerative phenomenon? Neuropathology 2018; 38:619-623. [PMID: 30187570 DOI: 10.1111/neup.12511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/29/2022]
Abstract
Xanthomatous changes can be observed in various conditions including primary xanthomatosis that is linked to an underlying hypercholesterolemia and more commonly associated with secondary xanthomatous degenerative processes in neoplasm and chronic inflammation. Meningioma with extensive xanthomatous change is exceedingly rare. The presence of cholesterol clefts within this peculiar meningioma subtype has not been described. Herein, we report an unusual case of xanthomatous meningioma in an 83-year-old normolipidemic woman, who presented to us with worsening lower limb weakness and global aphasia. There was increasing evidence to suggest that the presence of xanthomatous changes in long-standing meningioma is merely a sequela of cellular degeneration rather than true metaplastic change as previously hypothesized. Hence, the diagnosis of "xanthomatous meningioma" in the metaplastic category should be revisited and considered as a distinct histological subtype. The possible histogenesis of such intriguing phenomenon is discussed with a review of the literature.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Geok Chin Tan
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Ramesh Kumar
- Division of Neurosurgery, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur, Malaysia
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27
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Singh RK, Pattari S. Xanthomatous pleuritis. Respir Med Case Rep 2018; 23:143-144. [PMID: 29719802 PMCID: PMC5925762 DOI: 10.1016/j.rmcr.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 12/02/2022] Open
Abstract
This case presentation relates to a 21 year young male, cachectic in appearance, who presented with progressive shortness of breath, and dull pain on the lower part of the chest ongoing over three months. The patient received antitubercular drugs by local physician for suspected tuberculosis with no significant improvement. He was referred to our Respiratory Department for further evaluation of his chest pain and breathlessness. His X-ray showed moderate pleural effusion on the left side which confirmed by USG chest screening which showed multiple septation with thick parietal pleura and USG abdomen was normal. Moreover, the pleural effusion aspiration was performed and pleural fluid examination revealed exudative in character and thoracoscopic view of pleura was reddish with exudatives. Pleural biopsy histological examination showed mixed cell infiltrate with predominantly foamy macrophage along with plasma cells, lymphocytes and eosinophils with capillary proliferation. This is the first care report of xanthomatous pleuritis in the literature.
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Affiliation(s)
- Ranjit Kumar Singh
- Department of Respiratory Disease, Alexandra Hospital Worcestershire Acute, NHS Trust, UK
| | - Sanjib Pattari
- Department of Pathology, Rabindernath Tagore Institute of Cardiac Science, Kolkata, India
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Lopez JI, Elizalde JM, Calvo MA. Xanthogranulomatous Cholecystitis Associated with Gallbladder Adenocarinoma. A Clinicopathologic Study. of 5 Cases. TUMORI JOURNAL 2018; 77:358-60. [PMID: 1746061 DOI: 10.1177/030089169107700414] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The simultaneous presence of xanthogranulomatous cholecystitis and adenocarcinoma of the gallbladder has rarely been reported. A review of 53 cases of gallbladder adenocarcinoma in a 15-year period revealed 5 cases in which a concomitant diffuse xanthogranulomatous disease was observed. Clinical and pathologic features of these cases are commented and the diagnostic importance stressed. Both inflammatory and neoplastic components were closely mixed in 3 cases, thus making a prompt diagnosis difficult. Etiologic factors implicated in the development of both entities are considered.
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Affiliation(s)
- J I Lopez
- Departamento de Anatomia Patologica, Hospital Civil de Bilbao, Facultad de Medicina y Odontologia, Universidad del Pais Vasco/EHU, Spain
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Keorochana N, Klanarongran K, Satayasoontorn K, Chaiamnuay S. Necrobiotic xanthogranuloma scleritis in a case of granulomatosis with polyangiitis (Wegener's granulomatosis). Int Med Case Rep J 2017; 10:323-328. [PMID: 29042820 PMCID: PMC5633293 DOI: 10.2147/imcrj.s145943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to describe a case of necrobiotic xanthogranuloma scleritis in a 53-year-old male with unilateral progressive visual loss, scleritis, prolonged fever, and multiple mononeuropathy. Scleral biopsy showed necrosis with small abscess, and the pathological tissues revealed submucosal infiltration of mononucleated foamy histiocytes (xanthoma cells), hemosiderin-laden macrophages, neutrophils, lymphocytes, plasma cells, and erythrocytes without Touton giant cells or cholesterol clefts. Serum protein electrophoresis showed polyclonal gammopathy. All infectious investigations were negative. Afterward, this patient was diagnosed with granulomatosis with polyangiitis based on granuloma found in scleral tissue, vasculitis seen in sural nerve biopsy and positive serologies (C-ANCA and anti-PR3 antibody). He was treated with high-dose corticosteroid and later with intravenous cyclophosphamide monthly. He responded well to treatment, both eye and systemic conditions. Necrobiotic xanthogranuloma scleritis could be an early presentation of granulomatosis with polyangiitis.
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Affiliation(s)
| | | | | | - Sumapa Chaiamnuay
- Department of Medicine, Rheumatology Division, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Becker-Weidman D, Floré B, Mortelé KJ. Xanthogranulomatous pancreatitis: A review of the imaging characteristics of this rare and often misdiagnosed lesion of the pancreas. Clin Imaging 2017; 45:12-17. [PMID: 28554050 DOI: 10.1016/j.clinimag.2017.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
Xanthogranulomatous pancreatitis (XGP) is an extremely rare cause of a cystic pancreatic mass. The pathophysiology of this process is not entirely clear but likely results from a combination of duct obstruction, infection, and repeated hemorrhage. It is difficult to differentiate this inflammatory lesion from a cystic neoplasm and, therefore, in the majority of cases XGP is misdiagnosed as a neoplasm on preoperative imaging. In this report, we describe a case of XGP, the imaging characteristics of XGP, and a differential diagnosis for a cystic pancreatic lesion.
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Affiliation(s)
- David Becker-Weidman
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
| | - Bernard Floré
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| | - Koenraad J Mortelé
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses. AJR Am J Roentgenol 2017; 208:475-484. [PMID: 28095017 DOI: 10.2214/ajr.16.17075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Xanthogranulomatous (XG) processes are rare inflammatory conditions with the characteristic pathologic feature of lipid-laden macrophages or histiocyte cells. Imaging findings are nonspecific and can simulate aggressive neoplastic processes. XG processes can be caused by infection, inflammation, histolytic process, or an inherited lysosomal disorder. XG infectious processes are mainly seen in cholecystitis and pyelonephritis, but several other organs can also be involved. Histiocytic processes can be divided into Langerhans and non-Langerhans cell histiocytosis. The non-Langerhans cell histiocytosis entities include Erdheim-Chester disease, Rosai-Dorfman disease, juvenile xanthogranuloma, and hemophagocytic lymphohistiocytosis. The inherited lysosomal disorders resulting in XG processes include Nieman-Pick, Gaucher, and other lysosomal storage disorders. CONCLUSION Radiologists need to be able to recognize features of xanthogranulomatous processes to help facilitate patient management.
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Sunnapwar A, Menias CO, Ojili V, Policarpio Nicolas M, Katre R, Gangadhar K, Nagar A. Abdominal manifestations of histiocytic disorders in adults: imaging perspective. Br J Radiol 2016; 89:20160221. [PMID: 27332519 DOI: 10.1259/bjr.20160221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histiocytic disorders (HDs) are a diverse group of diseases characterized by pathologic infiltration of normal tissues by cells of the mononuclear phagocyte system. The spectrum of these diseases ranges from treatable infectious diseases to rapidly progressive, life-threatening conditions. Although they are rare and difficult diagnoses, HDs can be diagnosed with the help of clinical and laboratory analyses, imaging features and tissue biopsy. The clinicopathology and imaging spectrum of select entities belonging to this disorder are presented in this review.
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Affiliation(s)
- Abhijit Sunnapwar
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Vijaynadh Ojili
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Rashmi Katre
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Arpit Nagar
- 4 Ohio State University, Wexner Medical Center, Columbus, OH, USA
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Chon HK, Kim SW. [A Case of Xanthogranulomatous Inflammation of Terminal Ileum Presenting as a Mass in a Woman with Severe Obesity]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:277-281. [PMID: 27206441 DOI: 10.4166/kjg.2016.67.5.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Xanthogranulomatous inflammation is an acute or chronic inflammatory condition most frequently reported in pyelonephritis and cholecystitis. However, the involvement of the terminal ileum is extremely rare. Its clinical significance is that it can m imic a malignant lesion clinically and intraoperatively, as well as radiographically. A 34-year-old European ethnic female presented with gradually aggravated abdominal pain in right lower quadrant for 15 days. There was no significant medical, surgical or traumatic history, except class III obesity (BMI, 41.0 kg/m 2 ). An abdominal CT showed about a 4.7×3.7 cm sized, mass-like lesion in the terminal ileum. Despite symp tomatic treatment, her clinical symptoms did not improve. After six days, she underwent a laparoscopic ileocecectomy. Pathologic findings showed extensive inflammation with occasional multinucleated giant cells and aggregates of foamy histiocytes, consistent with xanthogran ulomatous inflammation. Here, we present a case of xanthogranu-lomatous inflammation in the terminal ileum presenting as subacute abdominal pain and a mass on imaging study. Xanthogranulomatous inflammation should be added to the differential diagnosis of patients with a suspected mass-like lesion in the terminal ileum.
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Affiliation(s)
- Hyung Ku Chon
- Division of Gastroenterology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sang Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Çavuşoğlu YH, Ardıçlı B, Apaydın S, Afşarlar ÇE, Yılmaz E. Xanthogranulomatous appendicitis in interval appendectomy specimens of children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
We report a rare case of xanthogranulomatous adrenalitis in a 55-year-old man. The patient presented to the hospital with fever, nausea, and right flank pain. His medical history was significant for diabetes and an adrenal mass that was detected 6 years prior to presentation during a computed tomography (CT) scan for trauma secondary to a motor vehicle collision. The mass was thought to be a myelolipoma. Magnetic resonance imaging (MRI) revealed a 12-cm right adrenal mass that was considered suspicious for carcinoma, which was surgically excised and cultured intraoperatively. The cultures subsequently grew methicillin-resistant Staphylococcus aureus (MRSA). Grossly, the adrenal mass was an encapsulated, necrotic lesion with surrounding areas of fat necrosis. On histologic examination, the tissue showed sheets of histiocytes, lymphocytes, and plasma cells diffusely involving the adrenal gland along with bright yellow lipofuscin crystals in a background of necrosis and fibrosis.
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Affiliation(s)
- Caitlyn Trotter Reed
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Sharma K, Singh V, Gupta S, Sankhwar S. Xanthogranulomatous cystitis with malacoplakia, leading to spontaneous intraperitoneal perforation of the urinary bladder in a 9-year-old girl. BMJ Case Rep 2015; 2015:bcr-2015-210786. [PMID: 26272961 DOI: 10.1136/bcr-2015-210786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 9-year-old girl presented with sudden onset continuous abdomen pain, oliguria and constipation for 2 days. Ultrasound of the abdomen and voiding cystourethrography revealed intraperitoneal perforation of the urinary bladder. Cystoscopy showed two perforations at the dome of the bladder. Open surgical repair of the perforations was performed and biopsy was taken from their edges. Histopathological examination of biopsied material revealed malacoplakia with xanthogranulomatous cystitis. The patient was doing well at 15 months follow-up. Xanthogranulomatous cystitis with malacoplakia leading to spontaneous bladder perforation has not been reported earlier in the English literature.
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Affiliation(s)
- Kuldeep Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saurabh Gupta
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, CSM Medical University (Upgraded KGMC), Lucknow, Uttar Pradesh, India
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Jakobsen JK. Editorial Comment from Dr Jakobsen to Usefulness of sonourethrography for penile abscess as a result of xanthogranulomatous granuloma in the corpus cavernosum of an adult: A case report. Int J Urol 2015; 22:791. [PMID: 26009979 DOI: 10.1111/iju.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jakob K Jakobsen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
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Minagawa T, Kato H, Ogawa T, Uehara T, Ishizuka O. Usefulness of sonourethrography for penile abscess as a result of xanthogranulomatous granuloma in the corpus cavernosum of an adult: A case report. Int J Urol 2015; 22:788-90. [DOI: 10.1111/iju.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/24/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Tomonori Minagawa
- Department of Urology; Shinshu University School of Medicine; Matsumoto Nagano Japan
| | - Haruaki Kato
- Department of Urology; Shinshu University School of Medicine; Matsumoto Nagano Japan
| | - Teruyuki Ogawa
- Department of Urology; Shinshu University School of Medicine; Matsumoto Nagano Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine; Shinshu University School of Medicine; Matsumoto Nagano Japan
| | - Osamu Ishizuka
- Department of Urology; Shinshu University School of Medicine; Matsumoto Nagano Japan
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40
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Xanthogranulomatous appendicitis causing an endometrial abscess: radiological findings. Wien Klin Wochenschr 2014; 127:970-3. [PMID: 25412596 DOI: 10.1007/s00508-014-0659-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/19/2014] [Indexed: 12/29/2022]
Abstract
Xanthogranulomatous inflammation (XGI) is a rare chronic inflammatory condition most commonly involving the kidneys and gallbladder. The condition is histopathologically characterized by the presence of foamy histiocytes, lymphocytes, and plasma cells. A few reports describing appendicitis caused by XGI have appeared in the English-language literature. However, no study has yet focused on the imaging features of xanthogranulomatous appendicitis (XGA). We present a pathologically confirmed case of XGA with an endometrial abscess; the patient underwent ultrasonography, computed tomography, and magnetic resonance imaging. To the best of our knowledge, this is the first case of XGA with uterine and right adnexal involvement presenting as a complicated pelvic abscess on radiological imaging.
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41
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Chieco PA, Antolino L, Giaccaglia V, Centanini F, Cunsolo GV, Sparagna A, Uccini S, Ziparo V. Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis. World J Gastroenterol 2014; 20:8717-8721. [PMID: 25024630 PMCID: PMC4093725 DOI: 10.3748/wjg.v20.i26.8717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/23/2013] [Accepted: 05/19/2013] [Indexed: 02/06/2023] Open
Abstract
Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder; its localization in the colorectal tract is extremely rare. The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of α1 and α2 proteins and C-reactive protein (17.5 mg/dL; normal value 0-0.5), and a palpable mass, localized in the right lower quadrant of the abdomen. A computed tomography scan showed a large right cecal mass with necrotic areas, local inflammation of retroperitoneal fat, and enlargement of local lymph nodes. Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition, the patient underwent right colectomy after 4 d of antibiotic treatment. Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve. We review the reports of large bowel tract XGI in the international literature.
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42
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Al-Rawabdeh SM, Prasad V, King DR, Kahwash SB. Xanthogranulomatous appendicitis in a child: report of a case and review of the literature. Case Rep Med 2013; 2013:498191. [PMID: 24093025 PMCID: PMC3777195 DOI: 10.1155/2013/498191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/05/2013] [Indexed: 12/29/2022] Open
Abstract
Xanthogranulomatous inflammation is a well-described inflammatory process, which may involve any organ but is most frequently encountered in the gall bladder and the kidney. There are rare reports of xanthogranulomatous appendicitis (XA) in the adult population, but only one brief mention of such a diagnosis in a child. In this report, we describe the case of an 11-year-old boy who presented with clinical signs and symptoms of acute appendicitis necessitating appendectomy. Upon microscopic examination, the appendix showed the typical features of XA. To the best of our knowledge, this is the first well-described case XA in a noninterval appendix in a child. We also reviewed the limited medical literature on the subject.
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Affiliation(s)
- Sura M. Al-Rawabdeh
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Vinay Prasad
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Denis R. King
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Samir B. Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
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43
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Histiocytic disorders of the gastrointestinal tract. Hum Pathol 2013; 44:683-96. [DOI: 10.1016/j.humpath.2012.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/12/2012] [Accepted: 05/16/2012] [Indexed: 12/27/2022]
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Yoon JS, Jeon YC, Kim TY, Han DS, Sohn JH, Nam KW, Nam YS, Pyo JY. Xanthogranulomatous inflammation in terminal ileum presenting as an appendiceal mass: case report and review of the literature. Clin Endosc 2013; 46:193-6. [PMID: 23614133 PMCID: PMC3630317 DOI: 10.5946/ce.2013.46.2.193] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/31/2012] [Accepted: 07/31/2012] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Jun Sik Yoon
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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45
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Singh V, John KM, Malik A, Pareek T, Dutta V. Xanthogranulomatous appendicitis: Uncommon histological variant of a common entity. Med J Armed Forces India 2013; 71:S19-21. [PMID: 26265827 DOI: 10.1016/j.mjafi.2012.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/12/2012] [Indexed: 12/18/2022] Open
Affiliation(s)
- Vikram Singh
- Resident, Dept of Pathology, Armed Forces Medical College, Pune, India
| | - K M John
- Resident, Dept of Pathology, Armed Forces Medical College, Pune, India
| | - Ajay Malik
- Associate Professor, Dept of Pathology, Armed Forces Medical College, Pune, India
| | - Tarun Pareek
- Resident, Dept of Surgery, Armed Forces Medical College, Pune, India
| | - Vibha Dutta
- Professor and HOD, Dept of Pathology, Armed Forces Medical College, Pune, India
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46
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Extrahepatic Soft Tissue Mimicking Applicator-Tract Implantation After Percutaneous Radiofrequency Ablation of Hepatic Malignancy. AJR Am J Roentgenol 2012; 199:453-7. [DOI: 10.2214/ajr.11.8165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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47
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Noro T, Gotohda N, Kojima M, Konishi M, Nakaghori T, Takahashi S, Hasebe T, Kinoshita T. Hepatocellular carcinoma with foamy histiocyte-like appearance: a deceptively clear cell carcinoma appearing variant. Case Rep Gastroenterol 2010; 4:286-92. [PMID: 21373386 PMCID: PMC3047759 DOI: 10.1159/000319545] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) shows many pathological features, and it varies architecturally and cytologically. There have been many reports and discussions of the morphological features of HCC. A 63-year-old man was found to have a solitary tumor in liver segment 7 that was diagnosed as HCC. A partial resection of liver segment 7 was performed. Microscopically, the tumor lesion showed a moderately differentiated HCC. There was also a lesion with foamy histiocyte-like cells corresponding to the white lesion in the face of the cut tumor. Immunohistochemical staining showed that they were negative for CD68, S-100, vimentin, and HMB-45. The cytoplasm itself was negative on periodic acid Schiff (PAS) and Sudan staining. Without immunohistological analysis, it is difficult to distinguish this HCC variant from clear cell carcinoma or metastases of renal cell carcinoma. It is important to recognize this type as a specific cytological variant of HCC that requires confirmation by immunohistochemistry. This report describes the case of a patient with a morphologically distinctive pattern of HCC with prominent cell cytoplasm that had a foamy histiocyte-like appearance. To the best of our knowledge, this is the first report of this HCC variant.
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Affiliation(s)
- Takuji Noro
- Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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48
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Webb A, Gillies M, Cadoux-Hudson T. Acute vasospasm following transcallosal resection of a xanthogranulomatous colloid cyst of the 3rd ventricle. Clin Neurol Neurosurg 2010; 112:512-5. [DOI: 10.1016/j.clineuro.2010.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 11/26/2009] [Accepted: 03/07/2010] [Indexed: 11/12/2022]
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49
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Neveling U, Kahn LB, Valderrama E, Poustchi-Amin M, Uckan D, Shende A. Deep Juvenile Xanthogranuloma: An Unusual Presentation. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Chen YF, Chao CM, Liu HN. Cutaneous plasma cell granuloma: report of a case with novel histologic and immunohistochemical findings. Int J Dermatol 2009; 48:409-11. [DOI: 10.1111/j.1365-4632.2009.03939.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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