Spectrum of Xanthogranulomatous Processes in the Abdomen and Pelvis: A Pictorial Review of Infectious, Inflammatory, and Proliferative Responses

Abstract

Objective: Xanthogranulomatous (XG) processes are rare inflammatory conditions with the characteristic pathologic feature of lipid-laden macrophages or histiocyte cells. Imaging findings are nonspecific and can simulate aggressive neoplastic processes. XG processes can be caused by infection, inflammation, histolytic process, or an inherited lysosomal disorder. XG infectious processes are mainly seen in cholecystitis and pyelonephritis, but several other organs can also be involved. Histiocytic processes can be divided into Langerhans and non-Langerhans cell histiocytosis. The non-Langerhans cell histiocytosis entities include Erdheim-Chester disease, Rosai-Dorfman disease, juvenile xanthogranuloma, and hemophagocytic lymphohistiocytosis. The inherited lysosomal disorders resulting in XG processes include Nieman-Pick, Gaucher, and other lysosomal storage disorders.

Conclusion: Radiologists need to be able to recognize features of xanthogranulomatous processes to help facilitate patient management.

Keywords: Erdheim-Chester disease; Rosai-Dorfman disease; cholecystitis; hemophagocytic lymphohistiocytosis; infection; inflammation; juvenile xanthogranuloma; pyelonephritis; xanthogranulomatous process.