Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.76
Peer-review started: October 11, 2020
First decision: November 3, 2020
Revised: November 12, 2020
Accepted: December 1, 2020
Article in press: December 1, 2020
Published online: January 27, 2021
Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts
Although a limited number of case reports on xanthogranulomatous appendicitis (XGA) have been published to date, no systematic literature analysis has been conducted.
The main objective of this study was to review the articles published in the medical literature on XGA. A secondary objective of this study was to present the medical history of a female patient diagnosed with XGA.
A systematic literature search was conducted on PubMed, Medline, Google Scholar, and Google databases using the following keywords: Appendix vermiformis, acute appendicitis, XGA, interval appendectomy, and appendectomy. The search included articles published before May 2020, and the publication language was not restricted.
A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. A total of 38 patients, 20 (52.6%) female and 18 (47.4%) male, aged from 3 to 78 years were included in this study. Fifteen patients' WBC values were reported, and 13 (86.7%) of them had leukocytosis. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy.
Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.
A review of the literature and our experience of appendiceal diseases suggest that XGA is usually identified after histopathological examination of the appendectomy specimen and XGA has no unique features in preoperative diagnostic studies. Therefore, the most important factors regarding the preliminary diagnosis of XGA are surgeon's experience, clinical suspicion and intraoperative findings.