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LETTER TO THE EDITOR
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 209-210

A rare case of xanthogranulomatous oopharitis


1 Department of Pathology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
2 Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India

Date of Web Publication23-Apr-2014

Correspondence Address:
Kanchan Murhekar
Cancer Institute (WIA),38, Sardar Patel Road, Chennai - 600 036, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131426

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How to cite this article:
Murhekar K, Majhi U, Senthilkumar A C, Sundersingh S, Sridevi V. A rare case of xanthogranulomatous oopharitis. J Can Res Ther 2014;10:209-10

How to cite this URL:
Murhekar K, Majhi U, Senthilkumar A C, Sundersingh S, Sridevi V. A rare case of xanthogranulomatous oopharitis. J Can Res Ther [serial online] 2014 [cited 2019 Sep 20];10:209-10. Available from: http://www.cancerjournal.net/text.asp?2014/10/1/209/131426

Sir,

Xanthogranulomatous inflammation is a chronic inflammation characterized by infiltration of tissues predominantly by lipid-laden foamy histiocytes, admixed with lymphocytes, plasma cells, and poly-morphonuclear leucocytes. This type of inflammation is commonly reported in kidneys. [1] Xanthogranulomatous inflammation has also been reported in gallbladder, stomach, anorectal area, bone, urinary bladder, testis, epididymis. [2] It is a rare condition with very few cases reported in literature. Clinically it presents as an adnexal mass and mimics ovarian malignancy. We present a case of xanthogranulomatous inflammation of both the ovaries.

A 36-year-old female presented to our institute with complaints of abdominal pain and weight loss of one year duration. She had no history of vomiting, haematemesis, bladder, and bowel complaints. Her appetite was normal and had no history of vaginal bleeding. Prior to coming to our institute, she underwent laparoscopy and biopsy from omental nodule at private hospital, which was reported as malignancy. The patient was referred to our institute for further evaluation.

Her menstrual history was unremarkable and she had four full term normal deliveries. She was not on any contraceptives. Her pelvic examination revealed a solid mass comparable to approximately 24 week size of gestation. The mass had restricted mobility. Uterus could not felt separately and cervix was pushed to left. Her chest X-ray, hemogram, and biochemical parameters were within normal limits. She was sero-negative for HIV and HBV.

Ultrasound abdomen and pelvis revealed right ovary measuring 3.9 × 3.2 cm with adherent cystic mass measuring 4.3 × 3 cm. Another cystic mass (11.5 × 12.1 cm) was seen in left adnexae and small quantity of free fluid seen in peritoneal cavity. CT scan revealed a large, well encapsulated cystic mass measuring 12.5 × 9.2 cm in pelvis, extending more towards left adnexae [Figure 1]. A small cystic lesion (4.3 × 3.1 cm) was seen in right adnexae. Omental nodule, approximately 1 cm in diameter was also seen in right iliac region. There was no space occupying lesion in liver and both kidneys were normal. The biopsy from omental nodule, done in the private hospital, revealed sheets of foamy histiocytes surrounded by inflammatory cells [Figure 1]. However, based on the clinical and radiological findings, diagnosis of bilateral adnexal mass was considered and pan hysterectomy with infra-colic omentectomy was planned.
Figure 1: Contrast-enhancing CT abdomen and pelvis showing a normal sized uterus with a complex mass left ovary with parietal infiltration.

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Intra-operatively, large left ovarian mass was found adherent to left parietal wall. The lesion was released all around and ovarian mass was sent for frozen section. A diagnosis of xanthogranulomatous oophoritis was made on frozen section as well as permanent sections, which showed sheets of foamy histiocytes, acute inflammatory infiltrate, endothelial cell proliferation, and few multi-nucleated foreign body giant cells [Figure 2].
Figure 2: Section showing sheets of foamy histiocytes, acute inflammatory infiltrate, endothelial cell proliferation, and few multi-nucleated foreign body giant cells (H and E, ×10)

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Xanthogranulomatous oophoritis is a rare condition. The exact etiology of the disease is unknown; organ obstruction, suppurative infections, and hemorrhage trigger tissue damage within the involved organs, usually eliciting a microscopic response of the disease process. [3] It can be misdiagnosed as ovarian malignancy on account of its presentation as adnexal mass. The microscopic picture of the condition with predominance of foamy histiocytes and abundant inflammatory cells could be misdiagnosed as lymphoma. Careful evaluation of the patient is necessary to avoid erroneous diagnosis and over-treatment as some of the cases reported in the literature had recovered spontaneously after antibiotic therapy. [4]

 
 > References Top

1.Antonakopoulos GN, Chapple CR, Newman J, Crocker J, Tudway DC, O'Brien JM, et al. Xanthogranulomatous pyelonephritis. A reappraisal and immunohistochemical study. Arch Pathol Lab Med 1988;112:275-81.  Back to cited text no. 1
    
2.Zhang XS, Dong HY, Zhang LL, Desouki MM, Zhao C. Xanthogranulomatous inflammation of the female genital tract: Report of three cases. J Cancer 2012;3:100-6.  Back to cited text no. 2
    
3.Hussain T, Elahi B, Long E, Mahapatra T, McManus PL, Kneeshaw PJ. Xanthogranulomatous inflammation involving latissimus dorsi donor site and implant breast reconstruction: [TAG:2]Case report[/TAG:2] and literature review. World J Surg Oncol 2012;10:166.  Back to cited text no. 3
    
4.Pace EH, Voet RL, Melancon JT. Xanthogranulomatous oophoritis: An inflammatory pseudotumor of the ovary. Int J Gynecol Pathol 1984;3:398-402.  Back to cited text no. 4
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