Xanthogranulomatous endometritis mimicking endometrial carcinoma: A case report and review of literature

Abstract

Xanthogranulomatous endometritis (XGE) is an extremely rare chronic inflammatory condition, which may be associated with endometrial hyperplasia, endometrial carcinoma, or cervical stenosis. Imaging features can be easily misdiagnosed as an aggressive malignancy. We present a case of XGE, which is the first case of XGE with serial multimodality imaging examinations, in addition to clinical, surgical and pathologic correlations. As such, this unique case illustrates the evolution of this rare disease.

Keywords: Endometrial carcinoma; Xanthogranulomatous endometritis; Xanthogranulomatous inflammation.

Fig. 1

On initial presentation in 2009, imaging investigations revealed an endometrial fluid collection on CT (A), which was anechoic with posterior acoustic enhancement on endovaginal ultrasound (B) (white arrowhead). On endovaginal (C) and 3-D sonography (D) of the uterus in November 2012, the fluid collection had increased in volume and progressed in complexity, with new internal echogenic debris (white arrows). No vascular flow was present on color Doppler interrogation. The findings in 2012 were suspicious for hematometra and/or debris.

Fig. 2

(A, B) During the acute presentation in 2014, CT demonstrated a heterogeneous uterine lesion, which had increased in size and complexity when compared to previous studies in 2012 (arrowheads). There was also a new rim enhancing abscess collection (curved arrow) apposing the mid left ureter and psoas muscle (C), causing mild hydroureteronephrosis (D, white arrow).

Fig. 3

Gross specimen of the uterus demonstrated firm, tan nodular tissue which replaced the entire endometrium and involved myometrium.

Fig. 4

(A) Abundant histiocytes, as demonstrated by CD68 stain; Xanthogranulomatous inflammation, as shown with hematoxylin and eosin (H&E) stain, involved the full thickness of the myometrium out to the serosa (arrow) (B), and extended to the cervix (C); there were scattered multinucleated giant cells (arrowheads) (D).