Clinical Endoscopy

Xanthogranulomatous Inflammation in Terminal Ileum Presenting as an Appendiceal Mass: Case Report and Review of the Literature: Jun Sik Yoon, Yong Cheol Jeon, Tae Yeob Kim, Dong Soo Han, Joo Hyun Sohn, Kil Woo Nam, Young Su Nam, Ju Yeon Pyo; Clin Endosc 2013;46(2):193-196. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.193

Xanthogranulomatous inflammation (XGI) is a rare benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages. This disease entity has been described in various organs but most commonly in the kidney and gallbladder. The occurrence of this disease in the lower gastrointestinal tract is extremely rare. Its clinical importance is that it can be misdiagnosed as an infiltrative cancer. In this case report, a 52-year-old male complained of right lower quadrant abdominal pain for a period of 3 months. Abdominal computed tomography revealed appendiceal mass and colonoscopy revealed multiple erythematous nodular lesions in the terminal ileum and appendiceal orifice, mimicking appendiceal cancer. Right hemicolectomy was done and the pathological specimen revealed XGI of the terminal ileum. To our knowledge, this is the first case of XGI in terminal ileum presenting as abdominal pain and the appendiceal mass on radiologic findings.

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William Wang, Maria Korah, Kovi E Bessoff, Jeanne Shen, Joseph D Forrester
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Xanthogranulomatous Inflammation of Gastric Wall Presented as a Submucosal Tumor: Si Hyung Lee, M.D. and Byung Ik Jang, M.D.; Korean J Gastrointest Endosc 2009;39(4):226-229. Published online October 30, 2009

Abstract PDF: Xanthogranulomatous inflammation is a rare condition characterized by aggregation of foamy histiocytes, fibrosis and parenchymal destruction. A 53-year-old man presented suffering from dyspepsia. Endosonography revealed a submucosal lesion that was a 2.6 cm-sized hypoechoic mass. We could not differentiate the lesion as a benign or malignant mesenchymal tumor, particularly a gastrointestinal stromal tumor, necessitating a wedge resection. The stomach wall was focally thickened, measuring 1.0 cm in size. No definite mass was grossly evident. Microscopic examination revealed multiple foamy histiocytes and subserosal fibrosis. Xanthogranulomatous inflammation of the gastric wall was diagnosed. (Korean J Gastrointest Endosc 2009;39:226-229)

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Xanthogranulomatous Inflammation Presenting as a Submucosal Mass of the Stomach: Min Kyoung Park, M.D., Hong Jun Yang, M.D., Chang Hoon Lim, M.D., Tae Ho Kim, M.D., Chang Whan Kim, M.D., Jean A Kim, M.D.^†, Wook Kim, M.D.* and Sok Won Han, M.D.; Korean J Gastrointest Endosc 2009;38(5):284-287. Published online May 30, 2009

Abstract PDF: Xanthogranulomatous inflammation is a rare chronic inflammatory condition that is characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells). Although the precise pathogenesis of xanthogranulomatous inflammation is not well understood, various mechanisms have been proposed, including chronic recurrent infection, the presence of gallstones, immunologic disorders and defective lipid transport. This disease entity is well recognized in the kidney and gallbladder, yet involvement of the gastrointestinal tract is extremely rare and the involvement of both the stomach and colon has never been reported on. A coexisting malignancy rarely has been reported in a patient with xanthogranulomatous inflammation. This might present as an inflammatory mass-like lesion with infiltration to the surrounding tissues, and so this often mimics advanced cancer. Therefore, a surgical operation together with careful pathological evaluation is required for making the precise diagnosis. We herein report on a case of xanthogranulomatous inflammation that presented as a submucosal mass in the stomach which was a huge irregular mass involving transverse colon. (Korean J Gastrointest Endosc 2009;38:284-287)

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