Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus: A case report and literature review

• Published in: Medicine (Baltimore) 2018-10, Vol.97 (40), p.e12615-e12615
• Main Authors: Chen, Tzu-Pai, Yi, Wan-Ling, Liu, Chiang-Shin, Lin, Yu-Hsuan
• Format: Article
• Language: English
• Subjects: Biopsy, Fine-Needle; Clinical Case Report; Diabetes Complications; Diagnosis, Differential; Humans; Male; Middle Aged; Neck - diagnostic imaging; Neck - pathology; Tomography, X-Ray Computed; Xanthomatosis - complications
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000012615

Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues. A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only. Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma. Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside. The patient recovered from the disease without posttreatment comorbidities. This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.