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Article Abstract

Xanthogranulomatous inflammation of the appendix is a rare pathological finding associated with appendicitis and chronic inflammation. Its clinical significance is not fully understood, and diagnosis is primarily based on the histopathological review as imaging findings with CT and ultrasound are non-specific. Here, we present a case of a 64-year-old female with recurrent appendicitis who underwent an appendectomy with final pathological findings consistent with xanthogranulomatous appendicitis (XGA). We discuss the higher reported incidence of XGA in interval appendectomy specimens compared to emergency appendectomies, and how this relates to its proposed pathophysiology. We found that XGA is associated with a more challenging operative field and the need to convert from a laparoscopic to an open procedure, increasing the potential risks of surgical complications. The potential development of XGA should be considered when planning an interval appendectomy as it may impact operative planning, although there is no clear consensus on its clinical significance.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441842PMC
http://dx.doi.org/10.7759/cureus.68322DOI Listing

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Article Synopsis
  • Xanthogranulomatous inflammation is a rare and chronic inflammatory condition, and its occurrence in the appendix of children, particularly in cases of appendicitis, is extremely uncommon.
  • An 8-year-old boy with Burkitt lymphoma underwent surgery for a mass in his abdomen, where doctors found that his appendix was discolored and abnormal, leading to an appendectomy.
  • The pathology report confirmed xanthogranulomatous appendicitis (XGA), showing distinctive yellow coloration of the appendix and characteristic inflammatory cell infiltration, marking a unique case in medical literature.
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Article Synopsis
  • Xanthogranulomatous inflammation of the appendix is a rare type of appendicitis that can happen because of ongoing inflammation, and doctors aren’t completely sure why it matters.
  • A study showed a 64-year-old woman had this condition after she had her appendix removed, and it can make surgery more complicated.
  • It’s more likely to be found in surgeries done at a later time rather than in emergencies, so doctors need to think about it when planning surgery to avoid problems.
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Article Synopsis
  • Xanthogranulomatous appendicitis (XGA) is a rare inflammatory condition of the appendix that can mimic cancer on imaging, making diagnosis challenging.
  • A 78-year-old woman with a history of cholangiocarcinoma presented with an irregular pelvic mass but showed no symptoms of appendicitis; despite fears of cancer recurrence, she was ultimately diagnosed with XGA through surgery.
  • This case highlights the difficulty in preoperatively diagnosing XGA, as it can present without typical symptoms or clear imaging indicators, often leading to confusion with malignancy.
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Nonneoplastic pathology of the appendix: A review article, based on the recent literature.

Am J Clin Pathol

May 2024

Department of Pathology, City of Hope, Duarte, CA, US.

Objectives: The appendix, although considered a vestigial organ, is of considerable clinical importance because acute appendicitis is a common medical problem. There are also other disease processes involving the appendix. The appendix is among the first specimens that the pathologist (and surgeon) cuts one's teeth on.

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Xanthogranulomatous appendicitis (XGA) is a rare process affecting the appendix vermiformis. Due to the atypical presentation of XGA, it is most commonly diagnosed post operatively on surgical pathology and is associated with interval appendectomies. Here, we describe a rare case of XGA diagnosed on pathology after acute appendicitis was found on routine Positron emission tomography scan for a minimally symptomatic patient with stage IV adenocarcinoma of the lung.

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