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Anandathirtha K, Shabnam Z, Manjeera L, Ramesh N. Xanthogranulomatous endometritis with unilateral salpingo-oophoritis in a postmenopausal woman masquerading as a malignancy. BMJ Case Rep 2023; 16:16/1/e247341. [PMID: 36657821 PMCID: PMC9853125 DOI: 10.1136/bcr-2021-247341] [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: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Kavya Anandathirtha
- Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Zulfiya Shabnam
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Lakshmi Manjeera
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Nikita Ramesh
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Pujani M, Singh K, Chauhan V, Khandelwal A, Chawla R, Ahuja R. Xanthogranulomatous Change in a Leiomyoma: First Report of an Extremely Rare Variant/Degenerative Change. J Midlife Health 2023; 14:60-62. [PMID: 37680373 PMCID: PMC10482019 DOI: 10.4103/jmh.jmh_158_22] [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: 08/30/2022] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 09/09/2023] Open
Abstract
Xanthogranulomatous inflammation, a specific form of chronic inflammation, is marked by parenchymal destruction, proliferative fibrosis, and infiltration of typical foamy histiocytes admixed with hemosiderin-laden macrophages and foreign-body giant cells. Myometrial xanthomatosis, a term designated for nodular or diffuse histiocytic hyperplasia of the myometrium, has been reported in association with pregnancy-related procedures. Moreover, a 2-3-fold increase in histiocytic counts has been observed in leiomyomatous areas than in adjacent normal myometrium. The first evidence of collections of lipid-laden macrophages was documented in the form of yellowish degeneration of uterine leiomyomas. We report a case of xanthogranulomatous change in a leiomyoma in a 47-year-old female who presented with abnormal uterine bleeding. To the best of our knowledge, this is the first report of xanthogranulomatous variant/degenerative change in a leiomyoma. This case highlights a new variant of leiomyoma which both gynecologists and pathologists should be aware of as it may pose a diagnostic challenge both clinically as well as pathologically.
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Affiliation(s)
- Mukta Pujani
- Department of Pathology, ESIC Medical College and Hospital, NIT, Faridabad, Haryana, India
| | - Kanika Singh
- Department of Pathology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Varsha Chauhan
- Department of Pathology, ESIC Medical College and Hospital, NIT, Faridabad, Haryana, India
| | - Aparna Khandelwal
- Department of Pathology, ESIC Medical College, Faridabad, Haryana, India
| | - Raina Chawla
- Department of Obs and Gynae, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Rashmi Ahuja
- Department of Obs and Gynae, ESIC Medical College and Hospital, Faridabad, Haryana, India
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Zhang M, Yin C, Chen Y, Wang J, Jiang J. Upstream stimulatory factor 2 (USF2) induced upregulation of triggering receptor expressed on myeloid cells 1 (TREM1) promotes endometritis by regulating toll-like receptor (TLR) 2/4-nuclear factor-kappaB (NF-κB) signaling pathway. Bioengineered 2022; 13:3609-3619. [PMID: 35100093 PMCID: PMC8973694 DOI: 10.1080/21655979.2022.2030619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Triggering receptor expressed on myeloid cells 1 (TREM1) participates in the development of endometritis. This study aims at identifying the effects and interaction of TREM1 and upstream stimulatory factor 2 (USF2) in endometritis by using a model of lipopolysaccharide (LPS)-induced human endometrial epithelial cells (HEnEpCs). ELISA was performed to determine the levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF-α) after LPS stimulation. TREM1 and USF2 expression was examined with RT-qPCR and Western blot. The JASPAR database was employed to predict the binding site between USF2 and TREM1, which was confirmed by luciferase reporter and chromatin immunoprecipitation assays. After TREM1 overexpression, IL-6, IL-1β, and TNF-α expression was detected by ELISA. Next, the binding of TREM1 to toll-like receptor (TLR) 2/4 was examined with co-immunoprecipitation. Then, proteins in TLR2/4-nuclear factor-kappaB (NF-κB) signaling in HEnEpCs under LPS condition were assessed by Western blot or immunofluorescence before and after TREM1 knockdown. Finally, TLR2 or TLR4 was silenced to explore whether intervene TLR2/4-NF-κB signaling pathway could rescue TREM1-overexpression-induced inflammation in LPS-induced HEnEpCs. Results revealed that upregulated TREM1 was observed in LPS-challenged HEnEpCs. Next, USF2 was found to have transcriptionally active TREM1 expression. Additionally, USF2 knockdown decreased the levels of IL-6, IL-1β, and TNF-α, whereas this effect was rescued after TREM1 overexpression. Besides, TREM1 could bind to TLR2/4 to regulate NF-κB signaling. Moreover, the intervention of TLR2/4-NF-κB signaling pathway rescued TREM1-overexpression-induced inflammation in LPS-stimulated HEnEpCs. Collectively, USF2 promotes endometritis by upregulating TREM1, thereby activating TLR2/4-NF-κB pathway.
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Affiliation(s)
- Miao Zhang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chengkun Yin
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Yan Chen
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Juan Wang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Jiang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Malik V, Chatterjee D, Goel B, Takkar N. Xanthogranulomatous Endometritis: A Benign Uncommon Masquerader of Malignancy. J Midlife Health 2019; 10:206-208. [PMID: 31942158 PMCID: PMC6947717 DOI: 10.4103/jmh.jmh_6_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Vipra Malik
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Bharti Goel
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
| | - Navneet Takkar
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
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Xanthogranulomatous endometritis mimicking endometrial carcinoma: A case report and review of literature. Radiol Case Rep 2018; 14:121-125. [PMID: 30386451 PMCID: PMC6205030 DOI: 10.1016/j.radcr.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/20/2022] Open
Abstract
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.
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Stewart CJR, Pearn A, Pachter N, Tan A. Peritumoral granulomatous reaction in endometrial carcinoma: association with DNA mismatch repair protein deficiency, particularly loss of PMS2 expression. Histopathology 2018; 73:428-437. [PMID: 29710374 DOI: 10.1111/his.13641] [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: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
AIMS The observation of peritumoral granulomatous reactions (PGRs) in two endometrial carcinomas (ECs) with a PMS2-deficient/MLH1-intact expression pattern led us to investigate whether PGRs in EC were specifically associated with DNA mismatch repair (MMR) protein deficiency, particularly PMS2 loss. METHODS AND RESULTS Hysterectomy specimens from 22 MMR protein-intact and 54 MMR protein-deficient ECs were reviewed with specific attention to the presence of a PGR and a tumour-associated lymphoid reaction [including tumour-infiltrating lymphocytes (TILs) and stromal lymphoid infiltrates]. The MMR protein-deficient ECs included 22 cases with combined MLH1/PMS2 loss, 11 with combined MSH2/MSH6 loss, 11 with isolated MSH6 loss, and 10 with PMS2 loss but intact MLH1 staining (including the two 'index' cases). Overall, PGRs were identified in seven of 54 (13%) MMR protein-deficient ECs, five of which showed a PMS2-deficient/MLH1-intact immunophenotype; three of these patients had germline PMS2 mutations and one additional patient had a germline MSH6 mutation. None of the MMR protein-intact tumours showed a PGR. Although five of the seven PGR-positive ECs had a high-grade histological component, six were stage I. Most ECs with PGRs also showed TILs and stromal lymphoid reactions, similarly to MMR protein-deficient ECs in general. CONCLUSIONS MMR protein-deficient ECs, particularly those with PMS2 loss, occasionally show PGRs in addition to stromal lymphoid infiltrates and TILs. Therefore, PGRs could be considered to constitute a histological prompt for consideration of Lynch syndrome. The potential prognostic significance of PGRs in EC requires further study.
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Affiliation(s)
- Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Western Australia, Australia.,School for Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Pearn
- Genetic Services of Western Australia, Perth, Western Australia, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Perth, Western Australia, Australia
| | - Adeline Tan
- Western Diagnostic Pathology, Perth, Western Australia, Australia
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Cervical xanthogranuloma in a case of postmenopausal pyometra. Obstet Gynecol Sci 2016; 59:411-4. [PMID: 27668207 PMCID: PMC5028651 DOI: 10.5468/ogs.2016.59.5.411] [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] [Received: 11/10/2015] [Revised: 02/17/2016] [Accepted: 03/02/2016] [Indexed: 11/30/2022] Open
Abstract
Xanthogranuloma is a non-neoplastic presentation of chronic inflammation commonly seen in gallbladder, kidney and rarely seen in genital organs. Only one case has been reported in cervix. Here, we report a case of 60-year-old postmenopausal lady who presented with history of fever and purulent discharge per-vaginum. On speculum examination, cervix had an ulcer extending from 3 to 5 o'clock position. Uterus was bulky. On probing the ulcer, a 1-cm deep sinus was identified. Ultrasound showed enlarged uterus and fluid collection suggestive of pyometra. Pyometra was drained and cervical biopsy was taken from the ulcerated lesion; histopathology revealed granulomatous inflammation with predominantly xanthous cells suggestive of tuberculosis. High index of clinical suspicion needs to be maintained in abnormal cervix. It is a perplexing and rare entity for a clinician and also a diagnosis of exclusion; only histopathology can help for diagnosis. It mimics like malignancy and chronic infections.
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Malik CA, Dudani S, Mani BNS. Xanthogranulomatous endometritis presenting as pyometra and mimicking carcinoma on imaging. J Midlife Health 2016; 7:88-90. [PMID: 27499597 PMCID: PMC4960947 DOI: 10.4103/0976-7800.185326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Col Ajay Malik
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt., New Delhi, India
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt., New Delhi, India
| | - Brig N S Mani
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt., New Delhi, India
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