Sura M. Al-Rawabdeh
senior specialist in Pediatric pathology
Title: Xanthogranulomatous Appendicitis in a Child: Report of a Case and Review of the Literature
Biography
Biography: Sura M. Al-Rawabdeh
Abstract
The patient is an 11-year-old boy who presented with a 1-day history of abdominal pain and emesis but no fever. His past medical history was unremarkable. In particular, there was no history of hemorrhagic problems or systemic disease. The family history was also unremarkable. On physical examina- tion, he had persistent and well-localized right lower quad- rant and right flank tenderness at the expected location of his appendix (McBurney’s point). The laboratory findings were unremarkable. WBC was 4.9 K/microliter with the following differentials: 49% segmented neutrophils, 41% lymphocytes, 9% monocytes, and 1% eosinophils. There was no evidence of anemia or thrombocytopenia (hemoglobin = 13 g/dL, hematocrit = 36%, and platelet count = 291 K/microliter). A computed tomography scan (CT-Scan) of the abdomen showed an enlarged appendix without inflammation; how- ever, ultrasound images showed a fluid-filled appendix with a diameter within the upper rages of normal. A subsequent physical examination revealed an increase in abdominal pain and tenderness, and, consequently, the patient underwent a laparoscopic appendectomy.
Gross evaluation showed a pink-tan appendix, measuring 8.3 cm in length and 1 cm in diameter. The serosal surface was unremarkable and cut surface demonstrated no fecalith. Microscopically, hematoxylin-eosin-stained sections of the tip of the appendix revealed numerous lipid-laden xanthoma cells in the mucosa which were surrounded by lymphocytes and plasma cells admixed with multiple mult- inucleated giant cells containing cholesterol clefts.The rest of the mucosa showed patchy mild neutrophilic infiltration.
The postoperative clinical course was unremarkable. The patient was discharged home the following day and had an unremarkable physical examination on a follow-up visit three weeks later