Xanthogranulomatous inflammation involving latissimus dorsi donor site and implant breast reconstruction: case report and literature review

Xanthogranulomatous Endometritis with calculus formation in setting of prolapsed uterus

Xanthogranulomatous inflammation is a rare benign inflammatory lesion characterized by sheets of lipid-laden foamy histiocytes. It has been reported in various organs, mainly the kidney and gall bladder. Xanthogranulomatous endometritis (XGE) is sporadic, with only a few cases reported in the English medical literature. Herein, we report a case of xanthogranulomatous endometritis with the formation of stones in a 50-year-old female patient with a prolapsed uterus. Grossly the endometrium was irregular, and the uterine cavity was filled with a yellow friable material, a polypoid growth, and yellowish stones. The microscopy showed sheets of histiocytes with few preserved endometrial glands. In this case, the xanthogranulomatous inflammation may mimic a clear cell carcinoma involving the endometrium and myometrium. One of the important differential diagnoses is malakoplakia. Immunohistochemistry and special stains are helpful in diagnosis.

Xanthogranulomatous inflammation and spindle cell proliferation in response to silicone breast implant leakage

This case study highlights the rare complications of silicone breast implants, as well as the diagnostic limitations of imaging. The patient initially presented with leakage of bilateral breast implants as discovered by a positron emission tomography (PET)-computerized tomography (CT) scan performed as part of a workup for small bowel Langerhans cell sarcoma metastases. The imaging results of the PET-CT scan revealed increased activity bilaterally with an enhancing, irregular, heterogeneously enhancing mass in the right breast. Given the clinical suspicion for breast implant-associated anaplastic large cell lymphoma, further investigation including surgical excision was undertaken. What initially was a concern for a serious complication of long-standing breast implants, fortuitously turned out to be a benign but exuberant xanthogranulomatous inflammatory reactive process. We hope that our report will add to the literature of this rare phenomenon and highlight it as a differential diagnosis of a mass in association with breast implants.

Role of conservative therapy prior to surgery in xanthogranulomatous mastitis: a case report

Background

Xanthogranulomatous mastitis is an extremely rare condition that is characterised by the infiltration of the breast parenchyma by foamy histiocytes. There have been only 26 reported cases amongst 10 publications. The clinical and radiological presentation of xanthogranulomatous mastitis often causes diagnostic confusion due to its similarity to breast cancer and other forms of chronic inflammatory mastitis. A histological diagnosis is often required either by core needle biopsy or excisional biopsy. Upon review of the literature, surgical excision was the most predominant mode of management.

Case Description

We present a case of xanthogranulomatous mastitis in a 40-year-old female who presented with clinical and radiological features of breast malignancy. This was a significantly large mass with a dimension of 90.7 mm by 36.4 mm, which if surgically excised, would have led to permanent cosmetic changes. Multiple core needle biopsies were completed to consider other differentials of histiocytic lesions including cystic neutrophilic granulomatous mastitis, histiocytoid lobular breast carcinoma, Rosai-Dorfman disease and Erdheim-Chester disease.

Conclusions

Clinical improvement was noted with reduction in size from prolonged antibiotic therapy suggesting an initial conservative approach in the management of xanthogranulomatous mastitis. By contributing our experience with xanthogranulomatous mastitis, we also present a review of literature on its aetiology, clinical features, and management of this pathology.

Xanthogranulomatous Breast Mass: An Unusual Presentation

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. 

Xantho-granulomatous mastitis preceded by cysts on ultrasound: Two cases with review of literature

Xantho-granulomatous mastitis (XGM) is a rare entity, only recently described in 2005. These lesions are often biopsied due to their clinical and radiological resemblance to breast cancer. With limited clinical experience, the etiopathogenesis and natural history of XGM remains unknown. We present two cases of pathologically proven XGM that were imaged at two time-points, with the findings alluding to the possibility of a precursor stage of cyst formation. In addition, we present a thorough review of all cases published to date and discuss the differential considerations and management implications of XGM.

Modern therapies and iatrogenic changes in breast pathology

Iatrogenic changes within the breast can provide challenges for the histopathologist in routine practice. Diagnostic procedures, such as core biopsies, result in reactive changes and can cause displacement of benign and malignant cells, the interpretation of which may cause difficulties in the resection specimen. Breast augmentation surgery with implants or injection of fillers, performed for cosmetic reasons or as part of a reconstructive process following removal of breast cancer, also produces reactive changes locally and at distant sites that may mimic cancer. The entity of implant-associated anaplastic large-cell lymphoma is now well recognized, with progress in our understanding of the underlying biological factors that drive its development. Chemotherapy and radiotherapy used in the treatment of breast cancer causes characteristic changes in normal breast tissue, and can alter the histological appearance and receptor status of the tumour. Radiotherapy to the breast, for breast cancer or childhood malignancies, increases the risk of developing a secondary malignancy in the breast long after treatment. In this review, we describe some of the iatrogenic changes that may be seen in histological specimens from the breast.

An unusual case of a ruptured Poly Implant Prothèse breast implant associated with xanthoma

A suspicious breast mass was intra-operatively found in a female patient previously operated for breast augmentation with the Poly Implant Prothèse (PIP) implants. The neoplasm was verified as xanthoma and an asymptomatic microrupture of PIP was also detected. This report discusses possible association of breast xanthoma with PIP implant rupture.

Xanthogranulomatous appendicitis in a child: report of a case and review of the literature

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.

Rupture of poly implant prothèse silicone breast implants: an implant retrieval study

BACKGROUND

Poly Implant Prothèse implants were recalled in Australia in April of 2010 following concerns of higher than expected rupture rates and the use of unauthorized industrial grade silicone as a filler material. Although subsequent investigations found that the gel filler material does not pose a threat to human health, the important question of what caused a relatively modern breast implant to have such a poor outcome compared with contemporary silicone breast implants is yet to be addressed.

METHODS

From a cohort of 27 patients, 19 ruptured Poly Implant Prothèse breast implants were subjected to a range of mechanical tests and microscopic/macroscopic investigations to evaluate possible changes in properties as a result of implantation. New Poly Implant Prothèse implants were used as controls.

RESULTS

All samples, explanted and controls, complied with the requirements for shell integrity as specified in the International Organization for Standardization 14607. Compression testing revealed rupture rates similar to those reported in the literature. Shell thickness was highly variable, with most shells having regions below the minimum thickness of 0.57 mm that was specified by the manufacturer. Potential regions of stress concentration were observed on the smooth inner surfaces and outer textured surfaces.

CONCLUSIONS

The high incidence of Poly Implant Prothèse shell rupture is most likely a result of inadequate quality control, with contributory factors being shell thickness variation and manufacturing defects on both inner and outer surfaces of the shell. No evidence of shell degradation with implantation time was determined.