Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus: A case report and literature review

Abstract

Rationale: Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues.

Patient concerns: A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only.

Diagnoses: Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma.

Interventions: Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside.

Outcomes: The patient recovered from the disease without posttreatment comorbidities.

Lessons: This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.

Figure 1

Pretreatment computed tomography with contrast shows a 4.7 × 3.7 × 3.5-cm heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. (A) Axial view. (B) Coronal view.

Figure 2

Histopathological photographs of the retrieved specimen. (A) Xanthoma cells (asterisk) (hematoxylin–eosin [H&E], original magnification ×400). (B) Touton giant cell (arrow) (HE ×200). (C) Immunohistochemistry analysis for S100-staining demonstrated negative results (original magnification ×400).