Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2008  |  Volume : 51  |  Issue : 3  |  Page : 458--459

Xanthogranulomatous cervicitis


Radhika Narayan, Minakshi Mishra, Rajesh Mohanty, TBK Sinha 
 Department of Pathology, Tata Main Hospital, Jamshedpur, Jharkhand, India

Correspondence Address:
Radhika Narayan
146/A, Professional Flats, B H Area, Kadma - Sonari Link Road, Kadma, Jamdshedpur - 831 005, Jharkhand
India




How to cite this article:
Narayan R, Mishra M, Mohanty R, Sinha T. Xanthogranulomatous cervicitis.Indian J Pathol Microbiol 2008;51:458-459


How to cite this URL:
Narayan R, Mishra M, Mohanty R, Sinha T. Xanthogranulomatous cervicitis. Indian J Pathol Microbiol [serial online] 2008 [cited 2021 Nov 30 ];51:458-459
Available from: https://www.ijpmonline.org/text.asp?2008/51/3/458/42537


Full Text

Sir,

Xanthogranulomatous inflammation is a well-established histologic entity characterized by xanthogranuloma composed of foamy histiocytes, hemosiderin laden macrophages and foreign body giant cells. Kidney, gall bladder, salivary glands and bones are well known to be involved by xanthogranulomatous inflammation. [1] Xanthogranulomatous inflammation of the female genital tract is rare. It most often affects the endometrium, but involvement of the cervix, vagina, fallopian tube and ovary may also rarely occur. [2]

Here, we report a case of a 47-year-old multigravida who was admitted to our hospital with complaints of excessive vaginal bleeding for the last 5-6 months. Her menstrual periods were irregular for the last 1 year. Per speculum examination showed an unhealthy area in the cervix at 7'o clock position. Ultrasound showed bulky uterus with midline echoes. PAP smears of cervix showed few clumps of cells with features of mild dysplasia. She subsequently underwent vaginal hysterectomy. On gross examination, the uterus with cervix measured 10 6 3.5 cm, external. Surface of the uterus showed adhesions and the cervix showed an area of erosion. Histologically, sections from the cervix showed normal squamous epithelium, subepithelially there was dense inflammatory cell infiltrate composed of collections of foamy histiocytes, few foreign body giant cells admixed with lymphocytes and plasma cells. A Gram stain of the cervical tissue showed few Gram-negative bacilli. However, neither epitheloid granulomas suggestive of tuberculosis nor malignancy was seen. Sections of the uterus showed midsecretory endometrium and there was no evidence of xanthogranulomatous inflammation in the endometrium. With the above findings, a histological diagnosis of xanthogranulomatous cervicitis was rendered. She was followed up for 6 months and was asymptomatic.

In their report of three cases of xanthogranulomatous inflammation of the female genital tract, Ladefoged et al. [2] found that only 19 cases had been reported in the literature. Xanthogranulomatous endometritis has also been reported in association with endometrial carcinoma. [3],[4] Russack and Lammers [3] have reported six cases of xanthogranulomatous endometritis, all associated with endometrial carcinoma that had been irradiated with external beam and/or intracavitary implants. The proposed mechanism of development may involve a complex interaction of elements such as obstruction, inflammation and a lipid source as well as generation of free radicals and lipid peroxidation, which are unique to the irradiated tissues. [3],[4] Two cases of xanthogranulomatous salpingitis have been reported in the literature. [5] Xanthogranulomatous reactions have been reported in the vagina and may be the result of unusual bacterial infections. [1] In our case, we found Gram-negative bacilli on Gram staining of the cervical sections.

On reviewing the literature, we found that only one case of xanthogranulomatous endometritis had been reported in the Indian literature and this may be the first case of xanthogranulomatous cervicitis to be reported from India.

References

1Rosai J. Rosai and Ackerman's surgical pathology. In : Rosai J, editor. 9 th ed. Missouri: Mosby; 1996. p. 1042-1043,1227,2142,1057875.
2Ladefoged C, Lorentzen M. Xanthogranulomayous inflammation of the female genital tract. Histopathology 1988;13:541-51.
3Russack V, Lammers RJ. Xanthogranulomatous endometritis: Report of six cases and a proposed mechanism of development. Arch Pathol Lab Med 1990;114:929-32.
4Pounder DJ, Iyer PV. Xanthogranulomatous endometritis associated with endometrial carcinoma. Arch Pathol Lab Med 1985;109:73-5.
5Furuya M, Murakami T, Sato O, Kikuchi K, Tanaka S, Shimizu M, et al . Pseudoxanthomatous and Xanthogranulomatous salpingitis of the fallopian tube: A report of four cases and a literature review. Int J Gynaecol Pathol 2002;2:56-9.