Xanthogranulomatous Endometritis with calculus formation in setting of prolapsed uterus

Abstract

Xanthogranulomatous inflammation is a rare benign inflammatory lesion characterized by sheets of lipid-laden foamy histiocytes. It has been reported in various organs, mainly the kidney and gall bladder. Xanthogranulomatous endometritis (XGE) is sporadic, with only a few cases reported in the English medical literature. Herein, we report a case of xanthogranulomatous endometritis with the formation of stones in a 50-year-old female patient with a prolapsed uterus. Grossly the endometrium was irregular, and the uterine cavity was filled with a yellow friable material, a polypoid growth, and yellowish stones. The microscopy showed sheets of histiocytes with few preserved endometrial glands. In this case, the xanthogranulomatous inflammation may mimic a clear cell carcinoma involving the endometrium and myometrium. One of the important differential diagnoses is malakoplakia. Immunohistochemistry and special stains are helpful in diagnosis.

Keywords: Endometritis; Endometrium; Histiocytes; Uterine Prolapse.

Figure 1. Gross view of the surgical specimen’s cut surface showing the irregular endometrium lined by yellowish friable material. The endometrial cavity shows the presence of yellow-colored stones (scale bar= 4,5 cm).

Figure 2. Photomicrographs of the uterus. A - uterine wall showing occasional endometrial glands and features of xanthogranulomatous endometritis. (H&E, X 40); B - endometrium showing sheets of lipid-laden foamy macrophages and other inflammatory cells (H&E, X 40).