Medicine:Xanthogranulomatous inflammation

From HandWiki
Xanthogranulomatous inflammation
Other namesXanthogranulomatous inflammation

The xanthogranulomatous process (XP), is a form of acute and chronic inflammation characterized by an exuberant clustering of foamy macrophages among other inflammatory cells. Localization in the kidney and renal pelvis has been the most frequent and better known occurrence followed by that in the gallbladder but many others have been subsequently recorded.[1][2][3] The pathological findings of the process and etiopathogenetic and clinical observations have been reviewed by Cozzutto and Carbone.[4]

Location

The xanthogranulomatous type of inflammation is most-commonly seen in pyelonephritis and cholecystitis, although it has more recently been described in an array of other locations including bronchi, lung, endometrium, vagina, fallopian tubes, ovary, testis, epididymis, stomach, colon, ileum, pancreas, bone, lymph nodes, bladder, adrenal gland, abdomen and muscle.[5] Telling apart clinically a XP from a tumor condition can be challenging as pointed out by several authors. Cozzutto and Carbone suggested that a wide array of entities characterized by a large content of histiocytes and foamy macrophages could be traced back at least in part to a xanthogranulomatous inflammation.[4] These include such varied disturbances as xanthoma disseminatum,[6] ceroid granuloma of the gallbladder, Whipple's disease,[7] inflammatory pseudotumor of the lung,[8][9] plasma cell granuloma of the lung,[10] malakoplakia,[11] verruciform xanthoma, foamy histiocytosis of the spleen in thrombocytopenic purpura,[12][13] isolated xanthoma of the small bowel,[14] xanthofibroma of bone,[15] and gastric xanthelasma.

A pathogenetic model might be suggested as follows:[citation needed]

  1. suppuration, hemorrhage and necrosis,
  2. granulomatous tissue with granular histiocytes and foamy macrophages,
  3. fibrohistiocytoma-like or plasma cell granuloma-like patterns,
  4. possible myofibroblast metaplasia.

A reactive fibrohistiocytic lesion simulating fibrous histiocytoma has been reported by Snover et al.[16] Reactive granular cells in sites of trauma have been regarded of histiocytic nature.[17] Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) might share several aspects of the XP. Likewise there might be some superimpositions between the XP and the plasma cell granuloma/histiocytoma-inflammatory myofibroblastic tumor complex.[18][19] The XP might be an important stage of this complex.

Histology

Under microscope, the cellular infiltrate includes neutrophils, lymphocytes, plasma cells, erythrocytes, hemosiderin-laden macrophages and prevalent foamy histiocytes. The latter are interspersed among other cells but often they cluster in a compacted mosaic-like pattern. The large lipid-laden macrophages display an eosinophilic or clear cytoplasm with a granular and vacuolated quality but can also have a spindle shape. Foreign body-type and Touton-type giant cells, calcospherites, cholesterol clefts and hemosiderin deposits are additional findings.[citation needed]

Hemorrhage, suppuration and necrosis are therefore the initial conditions leading to the xanthogranulomatous response. Plasma cells and fibrosis increase in later stages with the former being numerous and prominent. Proteus and Escherichia coli are the most commonly involved bacteria in xanthogranulomatous pyelonephritis. The foam cells of monocyte/macrophage origin are positive for KP1, HAM56, CD11b and CD68 as pointed out by Nakashiro et al. in xanthogranulomatous cholecystitis).[20] Many T lymphocytes were identified by these authors positive to CD4 and CD8. Macrophages and T lymphocytes demonstrated a marked expression of HLA-DR antigen. A delayed type hypersensitivity reaction of cell mediated immunity has been suggested in the pathogenesis of xanthogranulomatous cholecystitis.[20]

Destructive tumor-like masses with variable extension into adjacent fat and connective tissue can occur in cases involving organs such as kidney and gallbladder.[21]

See also

References

  1. ↑ "Xanthogranulomatous pyelonephritis (XGP): a local disease with systemic manifestations. Report of 23 patients and review of the literature". Medicine (Baltimore) 58 (2): 171–81. March 1979. doi:10.1097/00005792-197903000-00005. PMID 431402. 
  2. ↑ "Xanthogranulomatous cholecystitis". Am. J. Surg. Pathol. 5 (7): 653–9. October 1981. doi:10.1097/00000478-198110000-00007. PMID 7337158. 
  3. ↑ "Xanthogranulomatous cholecystitis. Histopathological study and classification". Pathol. Res. Pract. 186 (3): 383–90. June 1990. doi:10.1016/S0344-0338(11)80297-9. PMID 2377572. 
  4. ↑ 4.0 4.1 "The xanthogranulomatous process. Xanthogranulomatous inflammation". Pathol. Res. Pract. 183 (4): 395–402. August 1988. doi:10.1016/S0344-0338(88)80085-2. PMID 3054826. 
  5. ↑ Snoj, Z; Savic, N; Regvat, J (2015). "Late complication of a renal calculus: fistulisation to the psoas muscle, skin and bronchi". International Brazilian Journal of Urology 41 (4): 808–12. doi:10.1590/S1677-5538.IBJU.2014.0541. PMID 26401876. PMC 4757012. http://brazjurol.com.br/july_august_2015/Snoj_808_812.pdf. Retrieved 31 August 2015. 
  6. ↑ "Xanthoma disseminatum". Arch. Dermatol. 86 (5): 582–596. 1962. doi:10.1001/archderm.1962.01590110018003. 
  7. ↑ "Unique morphologic features of Whipple's disease. A study by light and electron microscopy". Gastroenterology 39: 454–68. October 1960. doi:10.1016/S0016-5085(19)35248-5. PMID 13712267. 
  8. ↑ "Plasma cell granulomas of the lung". Cancer 31 (1): 191–208. January 1973. doi:10.1002/1097-0142(197301)31:1<191::AID-CNCR2820310127>3.0.CO;2-D. PMID 4683037. 
  9. ↑ "Xanthomatous and inflammatory pseudotumors of the lung". Cancer 15 (3): 522–38. 1962. doi:10.1002/1097-0142(196205/06)15:3<522::AID-CNCR2820150312>3.0.CO;2-7. PMID 13921408. 
  10. ↑ "Endobronchial plasma cell granuloma (xanthomatous pseudotumor); a light and electron microscopic study". Hum. Pathol. 7 (4): 411–26. July 1976. doi:10.1016/S0046-8177(76)80055-X. PMID 939538. 
  11. ↑ "Malakoplakia of urinary bladder; report of four cases and discussion of etiology". AMA Arch. Pathol. 54 (4): 388–97. October 1952. PMID 12984945. 
  12. ↑ "Lipid-laden histiocytes in the spleen in thrombocytopenic purpura". American Journal of Clinical Pathology 43: 16–25. January 1965. doi:10.1093/ajcp/43.1.16. PMID 14259121. 
  13. ↑ "Foamy histiocytosis of the spleen in patients with chronic thrombocytopenia". Scand J Haematol 16 (1): 33–7. January 1976. doi:10.1111/j.1600-0609.1976.tb01113.x. PMID 1251138. 
  14. ↑ "Isolated xanthomatosis of the small bowel". Hum. Pathol. 16 (4): 422–4. April 1985. doi:10.1016/S0046-8177(85)80237-9. PMID 3980010. 
  15. ↑ "Xanthic variant of non-ossifying fibroma (so-called xanthofibroma) of the mandible. An ultrastructural study". Pathology International 32 (1): 135–42. January 1982. doi:10.1111/j.1440-1827.1982.tb02034.x. PMID 6176096. 
  16. ↑ "Reactive fibrohistiocytic proliferation simulating fibrous histiocytoma". American Journal of Clinical Pathology 76 (2): 232–5. August 1981. doi:10.1093/ajcp/76.2.232. PMID 6267932. 
  17. ↑ "Reactive granular cells in sites of trauma: A cytochemical and ultrastructural study". American Journal of Clinical Pathology 61 (2): 223–34. February 1974. doi:10.1093/ajcp/61.2.223. PMID 4359728. 
  18. ↑ Spencer H (November 1984). "The pulmonary plasma cell/histiocytoma complex". Histopathology 8 (6): 903–16. doi:10.1111/j.1365-2559.1984.tb02409.x. PMID 6098549. 
  19. ↑ "Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases". Am. J. Surg. Pathol. 19 (8): 859–72. August 1995. doi:10.1097/00000478-199508000-00001. PMID 7611533. 
  20. ↑ 20.0 20.1 "Xanthogranulomatous cholecystis. Cell composition and a possible pathogenetic role of cell-mediated immunity". Pathol. Res. Pract. 191 (11): 1078–86. November 1995. doi:10.1016/S0344-0338(11)80651-5. PMID 8822108. 
  21. ↑ Snoj, Z; Savic, N; Regvat, J (2015). "Late complication of a renal calculus: fistulisation to the psoas muscle, skin and bronchi". International Brazilian Journal of Urology 41 (4): 808–12. doi:10.1590/S1677-5538.IBJU.2014.0541. PMID 26401876. PMC 4757012. http://brazjurol.com.br/july_august_2015/Snoj_808_812.pdf. Retrieved 31 August 2015. 



Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Xanthogranulomatous_inflammation&oldid=3267749"