Morphological spectrum of xanthogranulomatous lesions masquerading malignancy: a 5-year retrospective clinicopathological study
Hemant Kumar, Shivani PrasharAbstract
Background:
Xanthogranulomatous inflammation (XGI) is an uncommon chronic inflammatory condition that affects multiple organ systems. Histopathologically, it is characterized by destructive tissue infiltration by sheets of lipid-laden, foamy macrophages, accompanied by a mixed inflammatory cell infiltrate. Although benign, it often mimics malignancy clinically and radiologically, creating significant diagnostic challenges and occasionally leading to unnecessary radical surgical management.
Aim:
This study aimed to assess the morphological spectrum, clinicopathological characteristics, and potential to mimic malignancy of xanthogranulomatous lesions (XGLs) over 5 years.
Materials and Methods:
This retrospective, observational study included all histopathologically confirmed cases of XGI diagnosed at a tertiary care center from January 2021 to December 2025. Clinical data, radiologic findings, and histopathologic features were reviewed. Cases with incomplete records were excluded from the analysis. Morphologic features and the presence of any associated malignancy were evaluated in detail.
Results:
A total of 38 cases were identified during the study period, with a mean age of 46.8 ± 13.4 years and a slight female predominance (male-to-female ratio = 1:1.3). The gallbladder was the most commonly affected organ (42.1%), followed by the kidney (28.9%) and the female genital tract (15.8%). Clinically or radiologically, nearly 76% of lesions were initially suspected to be malignant. Microscopic examination in all cases showed sheets of foamy macrophages associated with varying degrees of fibrosis, necrosis, and mixed inflammatory infiltrates. One case (2.6%) showed coexistent adenocarcinoma on extensive histopathological sampling.
Conclusion:
XGLs exhibit a wide histomorphological spectrum and often mimic malignancy in clinical and radiologic settings. Comprehensive clinicoradiologic assessment, together with meticulous histopathologic examination, is crucial for accurate diagnosis and for preventing unwarranted radical surgical interventions.