Disseminated coelomic xanthogranulomatosis in eclectus parrots (Eclectus roratus) and budgerigars (Melopsittacus undulatus)

Xanthogranulomatosis is an inflammatory lesion characterized by lipid-containing macrophages, extracellular lipid, hemorrhage, and necrosis. We describe disseminated intracoelomic xanthogranulomatosis in 5 eclectus parrots ( Eclectus roratus) and 2 budgerigars ( Melopsittacus undulatus). Postmortem, clinicopathologic, and historical case material was reviewed. Ages ranged from 3 to 24 years; there were 5 males and 2 females. Table food was included in the diet of 3/5 cases, and animal products were included in 2/3 cases. Common clinicopathologic abnormalities included leukocytosis (4/5 cases) and elevated concentrations of bile acids (3/4 cases) and cholesterol within 6 months prior to death (2/4 cases). At postmortem examination, all 7 birds had grossly visible, irregular, soft, tan to yellow, amorphous plaques distributed on the surfaces of the viscera and body wall. Histologic evaluation and oil red O stain revealed xanthogranulomatous inflammation with phagocytized and extracellular lipid, necrosis, cholesterol clefts, fibrosis, and mineralization. Infectious agents were not identified with special stains in all cases. Concurrent hepatobiliary disease was present in 6/7 cases, and 6/7 had lipid accumulation within the parenchyma of various visceral organs. Five cases had atherosclerosis of great vessels. We describe a unique form of disseminated coelomic xanthogranulomatosis in 2 psittacine species. This condition should be recognized as a differential diagnosis in cases of disseminated coelomic mass formation and coelomic distension in psittacine birds, particularly in eclectus parrots and budgerigars.

Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis

A broad spectrum of lesions, including hyperplastic, metaplastic, inflammatory, infectious, and reactive, may mimic cancer all along the urinary tract. This narrative collects most of them from a clinical and pathologic perspective, offering urologists and general pathologists their most salient definitory features. Together with classical, well-known, entities such as urothelial papillomas (conventional (UP) and inverted (IUP)), nephrogenic adenoma (NA), polypoid cystitis (PC), fibroepithelial polyp (FP), prostatic-type polyp (PP), verumontanum cyst (VC), xanthogranulomatous inflammation (XI), reactive changes secondary to BCG instillations (BCGitis), schistosomiasis (SC), keratinizing desquamative squamous metaplasia (KSM), post-radiation changes (PRC), vaginal-type metaplasia (VM), endocervicosis (EC)/endometriosis (EM) (müllerianosis), malakoplakia (MK), florid von Brunn nest proliferation (VB), cystitis/ureteritis cystica (CC), and glandularis (CG), among others, still other cellular proliferations with concerning histological features and poorly understood etiopathogenesis like IgG4-related disease (IGG4), PEComa (PEC), and pseudosarcomatous myofibroblastic proliferations (post-operative spindle cell nodule (POS), inflammatory myofibroblastic tumor (IMT)), are reviewed. Some of these diagnoses are problematic for urologists, other for pathologists, and still others for both. Interestingly, the right identification of their definitory features will allow their correct diagnoses, thus, avoiding overtreatment. The literature selected for this review also focuses on the immunohistochemical and/or molecular data useful to delineate prognosis.

Simulators of Urothelial Carcinoma

A broad spectrum of lesions, including hyperplastic, metaplastic, inflammatory, infectious, and reactive, may mimic cancer all along the urinary tract. This narrative collects most of them from a clinical and pathologic perspective offering urologists and general pathologists their most salient definitory features. Together with classical, well-known, entities such as urothelial papillomas (conventional and inverted), nephrogenic adenoma, polypoid cystitis, fibroepithelial polyp, prostatic-type polyp, verumontanum cyst, xanthogranulomatous inflammation, reactive changes secondary to BCG instillations, schistosomiasis, keratinizing desquamative squamous metaplasia, post-radiation changes, vaginal-type metaplasia, endocervicosis/endometriosis (müllerianosis), malakoplakia, florid von Brunn nest proliferation, cystitis/ureteritis cystica and glandularis, among others, still other cellular proliferations with concerning histological features and poorly understood etiopathogenesis like IgG4-related disease, PEComa, and pseudosarcomatous myofibroblastic proliferations (post-operative spindle cell nodule, inflammatory myofibroblastic tumor), are reviewed. Some of these diagnoses are problematic for urologists, other for pathologists, and still others for both. Interestingly, the right identification of their definitory features will allow their correct diagnoses thus avoiding overtreatment. The literature selected for this review also focuses on the immunohistochemical and/or molecular data useful to delineate prognosis.

XANTHOGRANULOMATOUS OOPHORITIS : A CASE REPORT

Xanthogranulomatous inflammation is a rare type of granulomatous inflammation and the cause is yet to be identified. In this pathology, the affected organ undergoes lysis and is replaced by dense inflammatory cell infiltrates. Here is a case of a 42 year old woman presenting with lower abdominal lump and pain for 3 months, clinical examination revealed a suspicion of tubo-ovarian mass, which on further hematological and radiological examination gave the impression of an ovarian neoplasm. Finally Histopathological study of the resected specimen came out as Xanthogranulomatous oophoritis (XO).

Cystic neutrophilic granulomatous mastitis during chemotherapy treatment for invasive breast carcinoma – a rare lesion that simulates tumor progression

Background Cystic neutrophilic granulomatous mastitis (CNGM) is an uncommon and recently described pattern of granulomatous mastitis. To our knowledge, no cases have been described during chemotherapy for invasive breast cancer. Case presentation A 42-year-old female patient had a diagnosis of invasive breast carcinoma (3-cm nodule). During neoadjuvant chemotherapy, she presented with an enlargement of the breast nodule that measured 7.0-cm on palpation. The lesion did not show typical inflammatory clinical findings and simulated tumor progression. A core biopsy showed granulomas with pseudocystic spaces with gram-positive bacilli (Corynebacterium sp.), and numerous circumjacent neutrophils. She was treated with antibiotics and resumed chemotherapy. Surgical specimen showed a 1.0-cm residual carcinoma and extensive xanthogranulomatous inflammation with no evidence of residual CNGM. Conclusion CNGM is usually associated with typical clinical presentation of mastitis. It is an important pattern of granulomatous inflammation to be recognized in the breast since it directly impacts treatment. The present case highlights its potential occurrence during chemotherapy treatment of breast cancer mimicking progression of breast malignancy.

Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of large number of lipid laden macrophages with an admixture of neutrophils, lymphocytes, plasma cells and multinucleated giant cells. It is misdiagnosed as ovarian tumour that leads to extensive surgery including hysterectomy. In this report we describe a case of Xanthogranulomatous salpingo-oophoritis along with review of literature.

Benign cyst with xanthogranulomatous inflammation involving the transverse colon and the common iliac artery

Xanthogranulomatous inflammation (XGI) is a rare process. Colonic XGI is extremely rare. We present a case report of XGI arising within an intra-abdominal cyst involving the transverse colon. A 28-year-old man presented with abdominal discomfort. He underwent a computed tomography abdomen–pelvis, which found three subcutaneous collections and a large cystic intra-abdominal structure. The decision was made for resection. Intraoperatively, the cyst originated from the pelvis and was adherent to the surrounding tissues. Histology from the lesion revealed XGI extending into the surrounding tissue. XGI is a rare inflammatory condition. Clinically, it can be difficult to distinguish XGI from an infiltrative malignancy. Therefore, it is usually necessary to obtain a pathological diagnosis of XGI. This case describes an atypical cystic lesion with XGI involving the transverse colon. Although rare, it should be considered in the potential differential diagnosis of an infective or malignant mesenteric cyst.

Xanthogranulomatous adrenalitis masquerading as a functioning adrenocortical malignancy: a case report

Introduction: Xanthogranulomatous adrenalitis (XA) is a rare chronic inflammatory disease of the adrenal glands and resembles adrenal neoplasm in clinical and radiologic characteristics. There is no report on XA presenting as a functioning adrenal mass in the literature. We present a case of XA mimicking a functioning adrenocortical carcinoma. Case report: A 52-year-old man presented with right flank pain, fever, vomiting, and loss of appetite for 2 weeks. He had signs of dehydration and elevated blood glucose level. Ultrasonography revealed a right adrenal mass. Contrast-enhanced computed tomography showed lobulated and necrotic mass replacing the right suprarenal gland and encasing the right renal vein, adjacent inferior vena cava, psoas, and diaphragm. There was loss of fat planes with liver and upper pole of the right kidney. Biochemical evaluation indicated increased serum and urine cortisol levels. As a sequel to hypercortisolism-induced hyperglycemia, he developed spontaneous chest wall abscess and bilateral sudden vision loss due to vitreous hemorrhages. Pus and blood culture grew methicillin-sensitive Staphylococcus aureus. Adrenal suppressant ketoconazole was administered for better glycemic control. With a diagnosis of locally advanced adrenocortical malignancy, right radical adreno-nephrectomy was performed, and cut section revealed a pus collection of around 100 mL. Histopathology examination showed xanthogranulomatous inflammation involving adrenal gland, Gerota’s fascia, psoas, and lymph nodes. Postoperatively, the patient recovered satisfactorily with favorable glycemic control. Conclusion: XA can mimic adrenal neoplasms both clinically and radiologically and is associated with staphylococcal infection. It warrants surgical excision and culture-based antibiotics and is mostly diagnosed on postoperative histopathology.

Inflammatory Pseudotumor Formation at a Port Site after Robotic Partial Nephrectomy for Renal Cell Carcinoma

Inflammatory pseudotumors (IPTs) are benign masses arising from nonspecific inflammatory conditions including surgical invasion. We herein report the rare case of an IPT mimicking port-site metastasis in a 69-year-old patient who underwent retroperitoneal robotic partial nephrectomy for stage T1a renal cell carcinoma. Radiological examination performed six months after the surgery revealed the presence of a mass underneath the abdominal wall which coincided with a port site. The tumor was resected by laparoscopic transperitoneal approach, and histological examination led to the diagnosis of an IPT that consists of xanthogranulomatous inflammation. We also discuss the etiology of IPT formation and features distinguishing IPTs from port-site metastasis.