Unusual Inflammatory Condition Disguised as Ovarian Cancer
A recently published medical case report highlights how deceptive some inflammatory diseases can be. In a case report titled, “A rare case report of Xanthogranulomatous peritonitis mimicking ovarian cancer, published in Radiology Case Reports, researchers describe a rare case of xanthogranulomatous peritonitis, an unusual inflammatory condition that initially appeared to be ovarian cancer.
The authors of this case report are Poonam Yadav, Shruti Kumar, Aya Almashad, Ahmed Abdelmonem, Kazi Amir Irfan, Suryakala Buddha, and Joe Jose.
The case involved a 22-year-old patient who presented to the hospital with fever, abdominal pain, weight loss, reduced appetite, and recurrent accumulation of fluid in the abdominal cavity, a condition known as ascites. Although these symptoms were already concerning on their own, what physicians observed on imaging studies raised even greater suspicion. A CT scan revealed a large, complex cystic mass in the abdominal and pelvic region, measuring more than 13 centimetres. As expected, clinicians initially suspected a malignant disease. However, one important detail did not fit this assumption.
The patient’s tumor markers were largely within normal limits, and a mild elevation of lactate dehydrogenase (LDH), an enzyme that can increase with tissue damage, was noted. This discrepancy between radiological findings and laboratory results suggested that something unusual might be occurring. To gain a clearer understanding, doctors decided to perform an exploratory laparoscopy, a minimally invasive surgical procedure in which a small camera is used to examine the abdominal cavity. During the procedure, surgeons observed a significant amount of ascites as well as thin adhesions connecting structures within the pelvis.
The key answer came from histopathological examination
The key answer came from histopathological examination, the microscopic analysis of collected tissue samples. Instead of tumor cells, pathologists identified clusters of lipid-filled immune cells known as “foamy macrophages.” These cells are characteristic of xanthogranulomatous inflammation, a rare form of chronic inflammatory response in which immune cells accumulate fats and form yellowish deposits within tissues. “Although well documented in its typical site, Xanthogranulomatous inflammation can present in atypical locations like peritoneum, often leading to diagnostic confusion,” the authors wrote in the study. This type of inflammation most commonly occurs in organs such as the gallbladder or kidneys, particularly in the setting of long-standing infections or obstruction. However, involvement of the peritoneum, the thin membrane lining the abdominal cavity and organs, is extremely rare. For this reason, clinicians often do not consider this diagnosis when evaluating large abdominal masses.
“Through our rare case of xanthogranulomatous peritonitis and its atypical presentation as an abdominopelvic mass, we seek to enhance awareness among clinicians and radiologists about the inclusion of xanthogranulomatous peritonitis in the differential diagnosis of multicystic abdominopelvic mass lesions. Especially when imaging and laboratory findings are incongruent. Awareness of this rare entity can help to avoid misdiagnosis and unnecessary extensive oncologic surgery. Definitive diagnosis requires histopathological confirmation, and surgical exploration may be warranted in ambiguous cases,” the scientists concluded.
Image: The Difference Between Ovarian and Cervical Cancer, Women’s Health and Menopause Center
