Xanthogranulomatous endometritis: case report

Xanthogranulomatous endometritis

Xanthogranulomatous endometritis (XGE) is an uncommon inflammatory benign condition that can mimic endometrial cancer. The majority of the reported cases of XGE have been observed in postmenopausal women, often presenting clinically as haematometra or benign senile pyometra. We report a case of XGE in a 73-year-old woman who presented with pyometra. Diagnostic hysteroscopy is an important tool when accompanied by endometrial samples for histology in suspected cases. Knowledge of this uncommon disease is crucial for accurate diagnosis. XGE is a benign condition, however, there have been reported cases of chronic active XGE and bacterial infection in which hysterectomy was required due to complications.

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.

Cervical xanthogranuloma in a case of postmenopausal pyometra

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.

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.

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 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.

Lethal outcome in xanthogranulomatous endometritis

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, while primary xanthogranulomatous endometritis (XE) is a very unusual finding, 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 present the case of a 69-year-old woman with a short history of abdominal pain and a palpable mass in the pouch of Douglas. Dilatation of the cervix drained a pyometra. Histological examination of the curettage rendered the diagnosis of XE. Microbiological studies revealed enterococcus spp. and Peptostreptococcus magnus. Despite antibiotic treatment the patient died of heart failure due to systemic inflammation. Autopsy confirmed the diagnosis of XE with transmural extension into the peritoneal cavity. Such a lethal course of XE is extraordinary. Proposed causes of XE include obstruction, infection and hemorrhage. Demonstration of enterococcus spp. and P. magnus supports the probable significance of bacteria in the development of XE. Because this condition may mimic malignant disease macroscopically and histologically, knowledge of XE is of major importance for both pathologists and gynecologists.

Ceroid-containing histiocytic granuloma of the endometrium

In an endometrial curettage specimen, taken from a 67-year-old woman with post-menopausal bleeding, the endometrium was replaced by aggregates of swollen histiocytes filled with yellowish-brown pigment. Histochemical and ultrastructural examination of the specimen revealed that the pigment was of ceroid nature. Previously reported cases with similar findings are reviewed, and the distinction of this type of endometrial lesion from 'foam cell reaction' is briefly discussed.

Xanthogranulomatous inflammation of the female genital tract

We describe three cases of xanthogranulomatous inflammation in the female genital tract--one affecting endometrium, tube and ovary, one affecting tube, ovary and parametrium and one confined to the endometrium. To date, xanthogranulomatous inflammation in the female genital tract has been reported in a total of 19 cases including the present three. The inflammation most often affects the endometrium but involvement of the vagina, cervix, fallopian tube and ovary may also occur.

Malakoplakia of the parotid gland

Xanthogranulomatous inflammation is an ubiquitous process that is most commonly observed in the kidney but may be observed in other organs. We report a case of xanthogranulomatous inflammation occurring in an enlarged parotid gland of a 65-year-old man as a result of salivary duct obstruction from sialolithiasis. We discuss the common histologic features and probably common aetiology of several inflammatory xanthograulomatous processes including malakoplakia.

The xanthogranulomatous process. Xanthogranulomatous inflammation

The precise histopathological features of the xanthogranulomatous process (XP) have been defined in an extensive review of all cases from various organs available in our files. The result was that the XP has the following aspecific but characteristic findings: the presence of granular, eosinophilic, PAS positive histiocytes in the initial stages; the mixture of foamy macrophages and activated plasma cells; the presence of suppurative foci and hemorrhages. Abscess, necrosis and most of all hemorrhages play a a role in eliciting this inflammatory response. This is in accordance with the observations so far reported in the literature. A very interesting result of our study is that some unquestionable cases of XP in cutaneous soft tissue had a histopathological picture indistinguishable from xanthoma. Basing on our experience and on an extensive study of the literature we suggest that the XP mechanism may in some way play a role in several diseases where the inflammatory or reactive nature is more or less ascertained or suspected and the secondary significance of foam cell production is overtly manifest.

Benign senile pyometra, endometrial cholesterol granulomas and adenosquamous carcinoma

Endometrial curettage of a 78-year-old patient with benign senile pyometra revealed endometrial cholesterol granulomas. Five years later cytological studies were suspicious of malignancy. Hysterectomy disclosed an endometrial adenosquamous carcinoma associated with cholesterol granulomas. We speculate that endometrial cholesterol granuloma, like endometrial xanthogranuloma, represents a rare morphologic variant of benign senile pyometra. Consequently a strong association with carcinoma is to be expected.

Histiocytic endometritis

Two cases of histiocytic endometritis are described, both characterized by total replacement of the endometrium with sheets of lipid-containing histiocytic cells. This condition appears to be a rare complication of cervical occlusion and it is suggested that the histiocytic reaction occurs as a response to a haematometra.

Xanthogranulomatous lymphadenitis

A case of an unusual type of granulomatous lymphadenitis, initially suspected of being a malignant lymphoma, is reported. Histologically, this lesion shows a striking xanthomatous appearance, due to collections of foamy histiocytes interspersed with chronic inflammatory cells, and resulting in a storage-like aspect. Evidence indicates that this process merely represents the reabsorption and healing phases of an acute suppurative lymphadenitis, with histopathologic features comparable to those of xanthogranulomatous pyelonephritis. The term xanthogranulomatous lymphadenitis is suggested for this previously inadequately described lesion, and the likely non-specific degenerative character of the xanthomatous response is stressed.