Lethal outcome in xanthogranulomatous endometritis

Xanthogranulomatous Endometritis: A Report of Two Cases

Xanthogranulomatous endometritis (XGE) or histiocytic endometritis is a chronic inflammatory pathology of rare presentation, characterized by an exaggerated inflammatory infiltrate that can mimic an endometrial carcinoma. We report two cases of this disease, one of them with a classic presentation of endometritis and the other one with a severe compromise in which the clinical presentation and imaging findings suggested a possible endometrial carcinoma. Knowledge of this unusual and rare pathology, including its etiopathogenesis, is important since it can be included in the differential diagnosis of endometrial carcinoma and, therefore, whenever it is found, to avoid excessive treatment.

Xanthogranulomatous endometritis with unilateral salpingo-oophoritis in a postmenopausal woman masquerading as a malignancy

Xanthogranulomatous endometritis (XGE) is a rare pathological entity which is characterised by sheets of foamy histiocytes and lymphoplasmacytic infiltrates. This condition can mimic endometrial carcinoma. We report a case, clinically suspected as carcinoma of the endometrium/ovary, which was diagnosed as XGE with left salpingo-oophoritis on histopathology.

Xanthogranulomatous endometritis: A case report and literature review

Xanthogranulomatous endometritis is a rare benign pathology mimicking endometrial carcinoma.

Xanthogranulomatous Endometritis: A Benign Uncommon Masquerader of Malignancy

Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes, lymphocytes, plasma cells, multinucleated giant cells, fibrosis, calcification, and accompanying polymorphonuclear leukocytes. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. We report the case of a 61-year-old postmenopausal female who presented with pyometra, bulky uterus, and cervical stenosis, and histopathology revealed XGE.

Xanthogranulomatous endometritis mimicking endometrial carcinoma: A case report and review of literature

Xanthogranulomatous endometritis (XGE) is an extremely rare chronic inflammatory condition, which may be associated with endometrial hyperplasia, endometrial carcinoma, or cervical stenosis. Imaging features can be easily misdiagnosed as an aggressive malignancy. We present a case of XGE, which is the first case of XGE with serial multimodality imaging examinations, in addition to clinical, surgical and pathologic correlations. As such, this unique case illustrates the evolution of this rare disease.

Xanthogranulomatous endometritis presenting as pyometra and mimicking carcinoma on imaging

Xanthogranulomatous endometritis (XGE) is an uncommon but well-established histopathological entity seen affecting the kidney and gallbladder. Involvement of the endometrium is very rare, with only a few case reports in world literature till date. Histologically, it is characterized by the replacement of the endometrium by sheets of foamy histiocytes, plasma cells, lymphocytes, giant cells, and siderophages. We present a case of a 74-year-old female who presented with foul-smelling discharge and postmenopausal bleeding of a short duration. Clinical examination and imaging studies revealed a pyometra, cervical stenosis. A suspicion of carcinoma was raised. Since XGE may mimic an endometrial carcinoma clinically and pathologically, knowledge of this unusual and rare inflammatory pathology is important for both the gynecologists and the pathologists.

Recurrent pyometra and xanthogranulomatous salpingitis: A rare pathologic association in a postmenopausal lady

Xanthogranulomatous inflammation is a rare, non-neoplastic variant of chronic inflammation. Of the 15 reported cases of Xanthogranulomatous endometritis, majority (60%) were accompanied by endometrial carcinoma. We herein report a case of a postmenopausal woman presenting with recurrent pyometra who was suspected to be case of cervical tuberculosis and treated for the same. Inspite of antitubercular therapy, she had cervical stenosis and developed recurrent pyometra over the next 2 years requiring repeated drainage. She then underwent hysterectomy and was found to have co-existent Xanthogranulomatous salpingitis (XGS) on histopathological examination. Xanthogranulomatous inflammation is a rare pathological diagnosis that gynecologists need to be aware of while managing such patients.

Xanthogranulomatous inflammation of the perimetrium with infiltration into the uterine myometrium in a postmenopausal woman: a case report

Background

Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to the normal tissue of affected organs. Although xanthogranulomatous endometritis and xanthogranulomatous salpingitis of the female genital tract has been described previously, to the best of our knowledge, this is the first report of xanthogranulomatous inflammation with infiltration into the uterine myometrium from the perimetrium without endometritis.

Case presentation

A 68-year-old Japanese woman with intermittent lower abdominal pain and low-grade fever who was initially treated with antibiotics underwent hysterectomy due to abscess formation in the posterior wall of the myometrium and perimetrium (the outer serosal layer of the uterus). Histopathological findings revealed that the abscess was caused by xanthogranulomatous inflammation with the granulation tissue and chronic inflammatory cells that consisted of focal and sheets of foam cells. The inflammation destroyed the perimetrial elastic lamina, and the myometrium was deeply infiltrated by the xanthoma cells. Neither endometritis nor salpingitis was coexistent with the xanthogranulomatous inflammation.

Conclusion

The patient was diagnosed as xanthogranulomatous inflammation, most likely arising from the perimetrium. Our findings suggest that the perimetrium, as well as the endometrium and adnexae, is one of the origins of xanthogranulomatous inflammation in female genital tract.

Xanthogranulomatous endometritis: an unusual pathological entity mimicking endometrial carcinoma

Xanthogranulomatous endometritis is an unusual pathological entity mimicking endometrial carcinoma. This shows sheets of foamy histiocytes alongwith other inflammatory cells. We, hereby, report a case of 45 year multigravida female with irregular menstrual history, clinically diagnosed as carcinoma and histopathologically turned out as xanthogranulomatous endometritis. So, this condition should always be dealt with caution, and pathologists and clinicians should be aware of it.

Histiocytic endometritis

PATIENT

Female, 72 FINAL DIAGNOSIS: Histiocytic endometritis Symptoms: Vaginal discharge • fever • weakness

MEDICATION

- Clinical Procedure: Endometrial and cervical biopsy Specialty: Pathology • Gynaecology.

OBJECTIVE

Rare disease.

BACKGROUND

Histiocytic or xanthogranulomatous endometritis, characterized by disappearance of endometrial mucosa and its replacement by sheets of lipid containing histiocytic cells, is very rare. Extensive internet and PubMed searches revealed only 19 cases reported to date. The pathogenesis of histiocytic endometritis seems to be inflammation due to post-menopausal cervical stenosis or as the result of cervical carcinoma. Histiocytic endometritis can infiltrate the myometrium and can mimic a malignancy.

CASE REPORT

We report the case of a 78-year-old post-menopausal female with symptoms of vaginal discharge, fever, and weakness. Radiological investigation showed a mass lesion in the cervix, extending into the myometrium, suggestive of cervical carcinoma. The lesion was biopsied and histopathological examination led to the diagnosis of histiocytic endometritis with no evidence of malignancy.

CONCLUSIONS

Histiocytic endometritis, an inflammatory pathology, can mimic malignancy clinically as well as radiologically. Histopathological examination with extensive sampling of tissue is essential because presence of endometritis does not rule out malignancy.

Xanthogranulomatous inflammation of the female genital tract: report of three cases

PURPOSE AND METHODS

This is a series of three cases diagnosed with xanthogranulomatous inflammation of the female genital with emphasis on the etiology, clinical-pathologic features and biological behavior. Clinical, pathologic, radiologic and follow up data are reported.

RESULTS

The three cases of Xanthogranulomatous inflammation of the female genital tract are the followings: 1) one case affecting the endometrium, 2) one case affecting the fallopian tube, and 3) one case confined to the ovary. The patient's age was 37, 22 and 62 year-old, respectively. Histologic examination revealed extensive infiltration of foamy histiocytes admixed with variable amount of inflammatory cells. The later include plasma cells, lymphocytes, and occasional multinucleated giant cells. Immunohistochemistry showed positive staining for CD68, a histiocytic marker, in foamy histiocytes, CD3, a T cell marker, and CD20, a B cell marker, in the background lymphocytes. The plasma cells were polyclonal with expression of both κ and λ light chains.

CONCLUSION

Xanthogranulomatous inflammation of the female genital tract is an unusual lesion, and clinically forms mass- like lesion in the pelvic cavity that invades the surrounding tissues, which may mimic the tumor clinically and by imaging.

Xanthogranulomatous inflammation: a rare cause of premature ovarian failure

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We report an unusual presentation of xanthogranulomatous inflammation of the genital tract in a young female presenting with premature ovarian failure. A 25-year-old unmarried female presented to the gynecology OPD with amenorrhea and lump abdomen for one and half years with weight loss and mucoid discharge per rectum for 2 months. On investigating, CECT showed a heterogeneously enhancing mass lesion with solid cystic components in pelvis. Cystic components showed enhancing walls and air fluid levels. Uterus and ovaries were not seen separately. There were multiple lymph nodes in retroperitoneum. Both LH and FSH were raised to post menopausal levels (FSH-69.35, LH-64.53). A provisional diagnosis of ovarian malignancy was made and a differential diagnosis of genital tuberculosis was kept and a decision for laparotomy was taken. Intraoperatively, there was a mass arising from the right side of fundus stuck to rectum. There was a pus pocket in the tumor. The final histopathological report was suggestive of endometrioma with xanthogranulomatous inflammation involving adjacent ovary and fallopian tube.

Xanthogranulomatous endometritis: a challenging imitator of endometrial carcinoma

Xanthogranulomatous inflammation is a distinguished histopathological entity affecting several organs, predominantly the kidney and gallbladder. So far, only a small number of cases of xanthogranulomatous inflammation occurring in female genital tract have been described, most frequently affecting the endometrium and histologically characterized by replacement of endometrium by xanthogranulomatous inflammation composed of abundant foamy histiocytes, siderophages, giant cells, fibrosis, calcification and accompanying polymorphonuclear leucocytes, plasma cells and lymphocytes of polyclonal origin. We present a case of a 69-year-old female complained of post menopausal bleeding and weight loss. Clinical preliminary diagnoses were endometrial carcinoma or hyperplasia and ultrasound was supposed to be endometrial malignancy, hyperplasia or pyometra by radiologist. Histopathological examination of uterus revealed xanthogranulomatous endometritis. Since xanthogranulomatous endometritis may mimic endometrial malignancy clinically and pathologically as a result of the replacement of the endometrium and occasionally invasion of the myometrium by friable yellowish tissue composed of histiocytes, knowledge of this unusual inflammatory disease is needed for both clinicians and pathologists.