Xanthogranulomatous Endometritis: A Challenging Imitator of Endometrial Carcinoma

Abstract

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.

Histiocytic endometritis

“…In 2007 Dogan-Ekici and Usubutun et al [2] reported 1 case of XGE mimicking endometrial carcinoma, as in the present case, which was mimicking cervical carcinoma both clinically and radiologically.…”

“…Our case also showed positivity for a microorganism (gram-positive cocci). However, Buckley et al [7] and Dogan et al [2] found no microorganism.…”

“…Because the histiocytes infiltrate the deeper tissues and can mimic malignancies such as clear-cell carcinoma [2], knowledge about the entity is essential for the pathologist, as it has an implication for treatment — histiocytic endometritis will require the correction of the cause, while malignancy will need surgery or chemotherapy.…”

“…Other variants are nodular histiocytic hyperplasia and ceroid-containing histiocytic granuloma . Histiocytic inflammation is an unusual condition that involves organs such as the kidney and gall bladder, which are subject to chronic obstruction with subsequent infection, but involvement of the uterus is rare [2]. Greater awareness of this condition is needed because it can mimic malignancy with infiltration into the myometrium.…”

Xanthogranulomatous endometritis coexisting with carcinoma cervix

“…Xanthogranulomatous endometritis (XGE) macroscopically mimics endometrial carcinoma, as it converts endometrium into friable yellowish tissue 1 . XGE is described in association with endometrial carcinoma 2,3,4 .…”