A Case of Xanthogranulomatous Inflammation (XGI) in the Omentum

Abstract

Xanthogranulomatous inflammation (XGI) is an inflammatory granuloma with lipid-laden foamy macrophages, commonly observed in the gallbladder and kidney. This report explores 91-year-old female patient, who after surgery of gastric cancer presented with left-sided abdominal discomfort. Abdominal CT revealed a nodule in the greater omentum drawing a suspicion of recurrence of peritoneal dissemination. Due to her advanced age, however, it was determined that the patient would not be able to tolerate chemotherapy treatment, therefore, surgery was performed to palliate the symptoms. The patient underwent open abdominal surgery for partial omentectomy of the nodule. Pathological examination showed weak fibrosis in the tissue, foci composed of histiocytes and foreign body-type giant cells, as well as abscesses, which led to the diagnosis of XGI. The exact pathogenesis of XGI remains unclear and various mechanisms have been proposed, including impaired lipid transport, immunological disorders, infection originating from low pathogenic organisms, reactions to specific infectious agents and lymphatic obstruction. In this case, anastomotic leakage during the gastric cancer surgery might have induced local inflammation and resulted in the formation of XGI. This report highlights a rare case of XGI in the omentum with a review of the pertinent literature.