Xanthogranulomatous orchitis: Review of the published work and report of one case

Xanthogranulomatous orchitis is an extremely rare inflammatory non-neoplastic destructive lesion of the testis. We report a 44-year-old man who presented with right scrotal swelling and two discharging sinuses. Testicular tumor markers were normal. Scrotal ultrasound showed heterogeneous testicular areas and irregular margin of the tunica. Surgical exploration revealed infected, unhealthy testicular tissue with necrosis and tumor-like lesion. Orchidectomy was done and histopathology showed xanthogranulomatous orchitis.     

Xanthogranulomatous orchitis in an adult Nigerian

Xanthogranulomatous orchitis (XGO) is a rare benign disease of the testis which has not been previously documented in tropical Africa. We report a case of a 24-year-old Nigerian man who presented with a painless left hemiscrotal swelling. Our clinical diagnosis was left testicular cancer. Testicular tumor markers were normal. At surgical exploration, we found a left testicular tumor. Histopathological examination of the specimen showed XGO of the left testis. He had left radical orchiectomy and left inguinal node dissection. He has remained stable 8 months after the treatment. Xanthogranulomatous orchitis cannot be distinguished clinically from testicular cancer unless by histopathological examination. Orchiectomy is the treatment of choice. However, in all patients and particularly young patients and those with a single testis, histopathological confirmation is suggested to avoid unnecessary radical orchiectomy, useless irradiation and ill-timed chemotherapy.     

Xanthogranulomatous cystitis

Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. Herein we report a case of a 70-year-old woman who presented with frequent, postmicturition pain and lower abdominal discomfort. Cystoscopy revealed a mass at the dome of the bladder near the left wall. Enhanced computed tomography (CT) demonstrated a mass with a central cavity. The patient underwent partial cystectomy because the presence of bladder neoplasm could not be ruled out. She had has no recurrence of XC 29 months after the operation. The present case of XC is the 20th to be reported in the world.     

黄色肉芽肿性胆囊炎的手术体会(附33例报告)

目的总结黄色肉芽肿性胆囊炎(xanthogranu lom atous cholecystitis,XGC)的手术治疗经验。方法回顾性分析我院1996年1月~2005年12月经病理确诊为XGC的33例病例资料。结果本组平均发病年龄60岁,男女比例为1.5∶1。术中所见:90.9%可见胆囊壁明显增厚;87.9%与周围组织有粘连;97%合并胆囊结石;15.2%合并胆总管结石;9.1%合并M irizzi综合征;12.1%合并胆囊内瘘。15例行胆囊切除术,7例行胆囊部分切除术,5例行胆囊切除 肝部分楔形切除术,6例行胆囊癌根治术。术中误诊率高达24.2%。9例行术中冰冻切片检查。5例术后出现并发症。结论XGC是一种特殊类型的胆囊慢性炎症,术前诊断困难。因与周围组织脏器粘连严重,术中易误诊为胆囊癌,故强调术中冰冻组织学检查。     

黄色肉芽肿性胆囊炎的诊疗特点

目的探讨黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)的诊断与手术治疗特点。方法回顾性分析13例经病理确诊的XGC病人的临床资料。术前B超检查13例,CT检查5例,MRI检查3例,ERCP检查1例,术前均误诊。结果11例行术中冰冻切片病理检查,确诊9例。9例行胆囊切除术,1例行胆囊切除加胆总管探查T管引流术,1例行胆囊大部切除加十二指肠瘘修补术,2例行胆囊切除加胆囊床部肝组织切除。均治愈,无死亡病例。结论XGC是一种少见的特殊类型的慢性胆囊炎,术前诊断困难,确诊依赖病理检查,开腹胆囊切除是基本手术方式。     

45例黄色肉芽肿性胆囊炎临床治疗分析

目的：研究黄色肉芽肿性胆囊炎与胆囊结石及高脂血症的关系,探讨胆囊结石和高脂血症在其发病中的作用。方法：回顾性分析45例经病理确诊为黄色肉芽肿性胆囊炎患者的临床资料。结果：45例均行手术治疗,术中发现合并胆囊结石45例,8例合并胆总管结石,3例合并Mirizzi综合征,合并高脂血症11例。经手术治疗后均痊愈。结论：黄色肉芽肿性胆囊炎的形成与胆囊结石和高脂血症有一定的联系。     

黄色肉芽肿性胆囊炎的诊治分析

目的探讨黄色肉芽肿行胆囊炎（xanthogranulomatous cholecystitis,XGC）的诊治。方法回顾性分析4例XGC的临床资料并复习相关文献。结果术前影像学诊断均未能明确诊断,全部病例均术后病理确诊。手术方式：3例行胆囊床肝脏楔形切除术、肝十二指肠韧带淋巴结清扫,1例行胆囊床肝脏楔形切除术、肝十二指肠韧带淋巴结清扫及部分结肠肝曲切除术,4例病人均治愈。均获随访,平均时间39个月（7个月～6年）,患者健康状况良好,无局部复发及恶变情况。结论 XGC是一种较为少见的胆囊炎,术前诊断较为困难,容易误诊为胆囊癌,确诊依赖病理检查,手术切除是治疗的最佳方法。术中冰冻病理检查可指导手术方案的实施。     

Xanthogranulomatous cholecystitis: A rare condition with variable presentations

Aim: Patients suffering from xanthogranulomatous cholecystitis have variable clinical presentations. The present study aims to evaluate the clinical presentations of the disease and the various surgical treatment strategies in the management of patients suffering from xanthogranulomatous cholecystitis. Methods: This is a retrospective study in a university teaching hospital and a tertiary referral centre. The histopathological records of 5016 resected gallbladder specimens from January 1991 to June 2007 were reviewed and case notes of patients with a diagnosis of xanthogranulomatous cholecystitis were retrieved. Results: Eighty‐six patients with xanthogranulomatous cholecystitis were identified. The spectrum of presentation was variable and a high proportion of patients had complicated pathology. Patients commonly presented with obstructive jaundice or acute cholecystitis. The proportion of patients with diabetes mellitus who presented with acute cholecystitis was higher than the local prevalence in this study. Conversion rate in laparoscopic cholecystectomy was also higher for patients with xanthogranulomatous cholecystitis. Conclusion: The clinical presentation of xanthogranulomatous cholecystitis is variable. The disease commonly presents as obstructive jaundice or acute cholecystitis but it may mimic carcinoma of the gallbladder. The disease carries a higher rate of conversion if laparoscopic cholecystectomy was attempted.     

Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst

Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non-calculous urinary tract obstruction.     

Xanthogranulomatous Cholecystitis. Retrospective Analysis of 12 Cases

Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in areas of destructive inflammation. The macroscopic appearance generally mimics a gallbladder carcinoma.

Twelve cases of xanthogranulomatous cholecystitis were identified from a retrospective analysis of the patient records of 770 cholecystectomy cases operated on in our department from January 1996 to October 2001. There were four men and eight women. Mean age of presentation was 52.5 years. Eleven patients had gallbladder stones. Seven patients had a history of acute cholecystitis and five patients of biliary colicky pain. Five cases were presented with obstructive jaundice and five with acute cholecystitis. Right upper quadrant mass was palpable in three patients. All patients underwent cholecystectomy. Open surgery was planned and performed in three patients. Laparoscopic cholecystectomy was planned in nine patients but converted to open surgery in three cases. Nine patients had an uneventful postoperative course. One patient developed wound infection and one patient a postoperative pulmonary infection. One patient developed acute abdomen in the 2^nd postoperative day and was re-operated for bile peritonitis. No mortality was seen in the series.     

Xanthogranulomatous orchitis. Report of 7 cases

The xanthogranulomatosis orchiepididymititis is a benign and a rare disease. Its etiology is unknown. It creates diagnosis, therapeutic and etiological problems. The diagnosis is hardly made because of the variability of the clinical findings. The confusion is mainly made with a malignant tumor, and sometimes with a simple orchiepididymitis. Orchidectomy is usually performed. We report seven cases of orchiepididymitis characterized by their antibiotherapeutic resistance, the destruction of the testis which needed a surgical removal. The diagnosis is established after the histological study of the testis. The etiology is not yet known. The authors study the clinical evolution and therapeutic characteristics of our serial comparing with the literature data.     

Xanthogranulomatous pyelonephritis: our experience with review of published reports

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.     

Xanthogranulomatous pyelonephritis: presentation and management in the era of laparoscopy

OBJECTIVE

To report a contemporary series of patients with xanthogranulomatous pyelonephritis (XGP, an inflammatory condition of the kidney that has traditionally been treated with open nephrectomy, ON), managed with either ON or laparoscopic nephrectomy (LN), as early reports suggest that the benefits of LN do not extend to patients with XGP.

PATIENTS AND METHODS

The medical and procedural records of patients with pathologically confirmed XGP between December 1993 to February 2004 were reviewed retrospectively. During this period, 26 patients (mean age 43.5 years, range 17–85) had surgical management of XGP; information on the mode of presentation, surgical management, hospital course and complications were analysed.

RESULTS

Twelve (46%) and 14 (54%) patients had ON and LN, respectively. The LN group had significantly lower blood loss (P = 0.002), transfusion rates (P = 0.02), time to resumption of oral intake (P = 0.002) and length of hospital stay (P = 0.002) than the ON group. One (7%) LN was converted to ON due to failure to progress. The overall complication rates between the ON and LN groups were not significantly different (P = 0.95).

CONCLUSIONS

LN in the setting of XGP is often difficult and requires advanced laparoscopic skills. In highly selected patients this approach can be offered, with acceptable morbidity, allowing for lower blood loss and shorter convalesce times.     

黄色肉芽肿性膀胱炎1例并文献复习

目的:提高黄色肉芽肿性膀胱炎(XC)的诊治水平。方法:对1例XC的临床诊治经过程进行回顾性分析。结果:XC临床症状不典型,膀胱镜检及影像学无特异性。结论:XC临床罕见,不易与其他膀胱疾病鉴别,诊断依靠病理组织学检查,治疗以手术切除为主。     

Xanthogranulomatous pyelonephritis with acquired cystic disease of the kidney in a haemodialysis patient

SUMMARY:   A 54-year-old-female patient who had received regular haemodialysis therapy for 12 years was referred to our hospital for evaluation of a left renal mass. Imaging examinations revealed acquired cystic disease of the kidney (ACDK) and a tumour-like lesion in the left kidney. Because of the preoperative diagnosis of the left renal cell carcinoma, the patient underwent a left nephrectomy. Pathological examination revealed xanthogranulomatous pyelonephritis. It was difficult to distinguish xanthogranulomatous pyelonephritis from renal cell carcinoma in our case, because it is very rare for xanthogranulomatous pyelonephritis to occur in ACDK.     

黄色肉芽肿性膀胱炎的临床特征与治疗（附7例报告）

目的：探讨黄色肉芽肿性膀胱炎（Xanthogranulomatous cystitis,XC）的临床诊断及治疗。方法：结合文献回顾性分析病理确诊为黄色肉芽肿性膀胱炎的7例临床资料。6例术前诊断为膀胱肿瘤,1例诊断为脐尿管肿瘤。6例行膀胱部分切除术,1例行脐尿管癌根治术。结果：7例XC临床表现缺乏特异性。大体观察见标本剖面可见灰黄色结节,部分可见坏死区域和（或）脓腔,内有脓液（黄色或褐色）。镜下可见大量黄瘤细胞（泡沫细胞）,其实质为含有脂质的巨噬细胞,伴有多核巨细胞、淋巴细胞等。7例均临床治愈。随访10-40个月（平均26个月）,患者无明显的尿频、尿急等症状,B超、CT未见肿物复发。结论：XC是一种良性但有破坏性的慢性特殊性炎性疾病,临床诊断困难,确诊依赖于病理组织学。保守治疗无效,以手术为主。     

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Objectives

To systematically review the current demographics, treatment and mortality rate associated with xanthogranulomatous pyelonephritis (XGP) and to test the hypothesis that the weighted pooled peri-operative mortality rate will be <10%.

Methods

Searches were performed of the Cochrane, Embase and Medline databases and the grey literature for studies published during the period 1 January 2000 to 30 August 2021. Eligible studies reported cohorts of ≥10 predominantly adult patients with XGP and described either average patient age or mortality rate.

Results

In total, 40 eligible studies were identified, representing 1139 patients with XGP. There were 18 deaths, with a weighted pooled peri-operative mortality rate of 1436 per 100 000 patients. The mean age was 49 years, 70% of patients were female and 28% had diabetes mellitus. The left kidney was more commonly affected (60%). Four patients had bilateral XGP, and all of whom survived. Renal or ureteric stones were present in 69% of patients, including 48% with staghorn calculi. Urine culture was positive in 59% of cases. Fistulae were present in 8%. Correct preoperative diagnosis occurred in only 45% of patients. Standard treatment continues to comprise a short cause of antibiotics and open radical (total) nephrectomy. Preoperative decompression occurred in 56% of patients. When considered at all, laparoscopic nephrectomy was performed in 34% of patients. Partial nephrectomy was conducted in 2% of patients.

Conclusions

Xanthogranulomatous pyelonephritis has a lower mortality rate than historically reported. A typical patient is a woman in her fifth or sixth decade of life with urolithiasis. While open radical nephrectomy remains the most common treatment method, laparoscopic, and to a lesser degree partial nephrectomy, are feasible in well selected patients.