Xanthogranulomatous gastritis of the remnant stomach mimicking a malignant tumor: A case report

Abstract

Xanthogranulomas are known to develop in the gallbladder and kidney. Xanthogranuloma of the stomach is a rare disease, and to the best of our knowledge, only a few cases have been reported to date. The present patient was a 64-year-old man who underwent a wide resection of the stomach following a Billroth-I reconstruction for a gastric ulcer ~40 years prior to the current presentation. Due to tarry stools, a gastrointestinal endoscopy was performed, leading to identification of an ulcerated gastric lesion located at the previous suture line at the lesser curvature of the remnant stomach. This lesion was elevated, appearing to indicate a submucosal tumor. Positron emission tomography revealed uptake of fluorodeoxyglucose radiotracer by the tumor. Although not indicated by the biopsy specimens, a malignant tumor of the remnant stomach was suspected, in the form of a malignant gastrointestinal tumor or remnant gastric cancer. Curative resection of the tumor was successfully performed. Histological examination of the resected specimens revealed xanthogranulomatous inflammation consisting of foamy histiocytes and plasma cells, however, no cancer cells were observed. The tumor was diagnosed as xanthogranulomatous gastritis that mimicked a malignant tumor of the remnant stomach. The present study therefore indicates that inflammatory tumors should be considered in the differential diagnosis of malignant tumors.

Keywords: inflammatory tumor; remnant stomach; stomach; xanthogranuloma; xanthogranulomatous gastritis.

Figure 1.

Endoscopic image of the tumor. The lesion was located at the previous suture line of the lesser curvature of the remnant stomach and was elevated, appearing to indicate a submucosal tumor with an ulcerated lesion.

Figure 2.

Abdominal computed tomography and positron emission tomography images of the tumor. (A) Computed tomography image revealing wall thickening in the lesser curvature of the remnant stomach (white arrow) and swollen regional lymph nodes (white arrowhead). (B) Positron emission tomography image revealing fluorodeoxyglucose radiotracer uptake by the tumor (white arrow).

Figure 3.

Macroscopic imaging of the resected remnant stomach. (A) Resected remnant stomach. The tumor was relatively soft similar to a lipoma, and measured 65×40 mm. (B) The tumor appeared to be a combination of a type 0-IIc lesion (white arrow) and a submucosal tumor (white arrowheads).

Figure 4.

Histopathological results of the tumor. Xanthogranulomatous inflammation, consisting of foamy histiocytes and plasma cells from the submucosal to subserosal layer, was observed by hematoxylin and eosin staining. (A) Whole image (low-power field; objective magnification, ×0.5). (B) A magnified view of the inset black box indicated in image A (low-power field; objective magnification, ×1.25). (C) A magnified view of the inset black box indicated in image B (high-power field; objective magnification, ×40).