Xanthogranulomatous sialadenitis

Xanthogranulomatous Sialadenitis, an Uncommon Reactive Change is Often Associated with Warthin's Tumor

Xanthogranulomatous sialadenitis (XGS) is rare in salivary glands and only reported in the literature as single cases. Here we report a cohort of four cases with XGS and summarize the clinicopathologic features of these cases. All four patients had persistent mass lesions concerning for neoplasm. In two patients (patient 1 and 3), the initial fine needle aspirations (FNAs) contained oncocytic cells consistent with or suspicious for Warthin's tumor, but follow-up FNAs showed only inflammation and/or debris indicating tumor infarction after FNA. All patients eventually had surgical resection. Histologically, all cases contained abundant macrophages with necrosis and fibroblastic proliferation. Warthin's tumor with a grossly identifiable tumor nodule (0.7 cm) was noted in patient 1 and a microscopic focus (0.2 cm) of Warthin's tumor was identified in patient 3. No identifiable tumor was observed in patient 2 and 4. There are a total of 10 XGS cases in the literature (including four from this series) and Warthin tumor was identified in 50% of reported cases of XGS, suggesting that XGS is an uncommon reactive process to spontaneous or procedure-induced infarction of Warthin tumor. As a diagnostic mimicker for malignancy, a thorough examination and generous sampling of surgical resection specimen is warranted, although a benign salivary gland neoplasm, commonly Warthin's tumor, is often identified.

Primary Necrobiotic Xanthogranulomatous Sialadenitis with Submandibular Gland Localization without Skin Involvement

Necrobiotic xanthogranulomatous reaction is a multiorgan, non-Langerhans cell histiocytosis with an unknown etiology. Occurrence in the salivary gland is extremely rare. We recently identified a case of necrobiotic xanthogranulomatous sialadenitis in a 73-year-old Korean woman who presented with a painless palpable lesion in the chin. There was no accompanying cutaneous lesion. Partial resection and subsequent wide excision with neck dissection were performed. Pathological examination showed a severe inflammatory lesion that included foamy macrophages centrally admixed with neutrophils, eosinophils, lymphocytes, plasma cells, and scattered giant cells, as well as necrobiosis. During the 12-month postoperative period, no grossly remarkable change in size was noted. Necrobiotic xanthogranulomatous inflammation may be preceded by or combined with hematologic malignancy. Although rare, clinicians and radiologists should be aware that an adhesive necrobiotic xanthogranuloma in the salivary gland may present with a mass-like lesion. Further evaluation for hematologic disease and close follow-up are needed when a pathologic diagnosis is made.

Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus: A case report and literature review

RATIONALE

Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues.

PATIENT CONCERNS

A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only.

DIAGNOSES

Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma.

INTERVENTIONS

Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside.

OUTCOMES

The patient recovered from the disease without posttreatment comorbidities.

LESSONS

This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.

Xanthomatous sialadenitis: Autoimmune- or treatment-induced lesions?

Xanthomatous sialadenitis (XS) is rarely reported. Here we report XS in a case of HLA-B27-positive ankylosing spondylitis showing also anti-MAG-positive polyneuropathy with IgM-kappa dysimmunoglobulinemia/paraproteinemia, lung small cell carcinoma and buccal squamous cell carcinoma (SCC). The lesions were identified in submandibular and labial minor salivary glands of a neck dissection specimen (made during a buccal 1.7 cm large SCC resection procedure). The oral SCC was resected at 8 months after the diagnosis of the lung small cell carcinoma (with skull dome metastases, revealed by a superior cava syndrome) and at 2 months after radiotherapy. The microscopic XS-lesions consisted in multifocal accumulations of CD68-positive macrophages. Plasmocyte-abundant foci (CD138-positive) were extra-xanthomatous (atrophic parenchyma, zones of adipose involution). CD138 was also expressed in ductal cells and in acini (focally). In conclusion, we report XS of submandibular and labial minor salivary glands, occurring in the context of a HLA-B27-positive ankylosing spondylitis, polyneuropathy with IgM-kappa dysimmunoglobulinemia and anti-MAG antibodies in a case of small cell lung carcinoma (treated by radio-chemotherapy) and oral SCC.

[Patterns of xanthogranulomatous reaction in salivary glands. Histomorphological spectrum and differential diagnosis]

Xanthogranulomatous inflammation is an uncommon subtype of chronic inflammatory processes that has been mainly reported in the kidneys, gallbladder and other less common sites. Due to the presence of tumefactive mixed inflammatory infiltrates with variable involvement of surrounding soft tissues, this benign condition is often mistaken for a malignancy on clinical examination. In the salivary glands xanthogranulomatous inflammation is rare and mainly represents reactive changes secondary to a preexisting lesion, in particular infarcted Warthin tumors as well as ruptured ductal cysts and other sialectatic ductal changes. A special type of xanthogranulomatous salivary gland disease is represented by the rare primary (idiopathic) xanthogranulomatous sialadenitis without identifiable predisposing parenchymal or ductal lesions. The histological differential diagnosis is mainly based on the dominant histological pattern and encompasses among others inflammatory pseudotumors of various etiologies (e.g. inflammatory myofibroblastic tumor, IgG4-related disease and sarcoidosis), neoplastic and paraneoplastic xanthogranulomatosis, malignant lymphoma and carcinoma with secondary xanthogranulomatous reactions. Thus, identification of the underlying lesion is necessary for correct classification and to avoid overlooking more serious neoplastic or autoimmune diseases.

Xanthogranulomatous sialadenitis clinically mimicking a malignancy: case report and review of the literature

BACKGROUND

Xanthogranulomatous tissue reaction is a well-documented process that is most common in kidney. There are other uncommon sites being documented as case reports in the literature. We would like to describe the clinicopathologic findings in a case of xanthogranulomatous sialadenitis that involved the parotid gland, which was clinically thought to be a tumoral mass, and compare it with the 4 previously reported cases.

CASE REPORT

A 52-year-old man presented with a left parotid mass. Fine needle aspiration biopsy was consistent with Warthin's tumor. The mass lesion was excised.

DISCUSSION

The lesion measured 2.5 × 1.5 × 1.5 cm. Microscopic examination revealed sheets of foamy macrophages centrally admixed with neutrophils, eosinophils, lymphocytes, plasma cells and scattered giant cells indicating a xanthogranulomatous reaction. As a conclusion xanthogranulomatous tissue reaction can mimic neoplasms.

Xanthogranulomatous Sialadenitis: A Case Report and Literature Review

Xanthogranulomatous tissue reaction is an uncommon but well-documented process that occurs at many sites in the body. It is most often recognized in the kidney and gallbladder, where its etiology is believed to involve an outflow obstruction. We report the case of a man with a parotid mass that exhibited features consistent with an inflammatory process on fine-needle aspiration biopsy. The mass persisted despite medical management, and the patient subsequently underwent a superficial parotidectomy. Histologic examination of the resected specimen identified a xanthogranulomatous tissue reaction adjacent to a Warthin's tumor. We compare the features of this case with those of the 2 previously reported cases of xanthogranulomatous sialadenitis, and we discuss its possible etiologies.

Chronic sclerosing sialadenitis (Kuttner's tumor): unusual presentation with bilateral involvement of major and minor salivary glands

In 1896 Kuttner reported four cases which he described as induration of the submandibular gland. Histologically, they showed chronic inflammation and fibrosis. Sporadic cases of this entity that have come to be known as Kuttner's tumor or chronic sclerosing sialadenitis of the submandibular gland and have been reported throughout the 20th century. This inflammatory tumor has been under-recognized, and awareness of its importance and probable immunologic background have recently become evident. We report an unusual case of chronic sclerosing sialadenitis, affecting both parotid glands, both submandibular glands, and minor salivary glands of the oral cavity, and explore the immunohistochemical profile of this entity.

Lymphoma presenting as parotid xanthogranulomatous sialadenitis

We present a case of disseminated high-grade, T-cell-rich B-cell lymphoma in a 72-year-old white woman that presented as unilateral parotid swelling, and was initially diagnosed as xanthogranulomatous sialadenitis.

Xanthogranulomatous cystitis associated with malignant neoplasms of the bladder

AIMS

Two cases of xanthogranulomatous cystitis in conjunction with malignant neoplasms of the bladder are described.

METHODS AND RESULTS

A partial cystectomy [corrected] specimen from a 55-year-old man showed a urachal adenocarcinoma partly surrounded by a large xanthogranulomatous inflammatory mass. Multiple resections of the locally recurring tumour over the subsequent 10 years did not show further xanthogranulomatous changes. In the second case, a 76-year-old woman, a focus of xanthogranulomatous cystitis was present near a moderately differentiated transitional-cell carcinoma of the vesico-ureteric junction.

CONCLUSIONS

Xanthogranulomatous inflammation is associated with malignant neoplasms in the bladder as it is in the kidney and extra-urinary sites, as well as with benign neoplasms and non-neoplastic conditions such as urachal diverticula. The presence of a concomitant neoplasm should therefore be considered when the diagnosis of xanthogranulomatous cystitis is made.