BACKGROUND 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. AIM To review the medical literature on xanthogranulomatous appendicitis (XGA). METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were “appendix vermiformis,” “appendectomy,” “acute appendicitis,” and “XGA.” The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study. RESULTS A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. 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. CONCLUSION 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. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies. Key Words: Appendix vermiformis, Acute appendicitis, Appendectomy, Interval appendectomy, Xanthogranulomatous inflammation, CD68 antibody staining Core Tip: 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. Xanthogranulomatous appendicitis (XGA) has rarely been reported to date. In this review article, we present a patient with XGA, and review data from all articles published on this rare situation. This review study shows that XGA 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.

Akbulut S, Demyati K, Koc C, Tuncer A, Sahin E, Ozcan M, Samdanci E. Xanthogranulomatous appendicitis: A comprehensive literature review. World J Gastrointest Surg 2021; 13(1): 76-86 [PMID: 33552395 DOI: 10.4240/wjgs.v13.i1.76]

Title

World Journal of Gastrointestinal Surgery

Publisher

Baishideng Publishing Group Inc

Publisher Country

United States of America

Indexing

Scopus

Impact Factor

2.582

Publication Type

Both (Printed and Online)

Volume

13

Year

2021

Pages

76-86