Intraperitoneal "golden yellow" in a pediatric patient with Burkitt lymphoma: Xanthogranulomatous appendicitis

Xanthogranulomatous inflammation is a rare chronic inflammatory reaction. Appendiceal involvement in the pediatric age group is extremely rare. We present a case of xanthogranulomatous appendicitis (XGA) that was detected incidentally during the excision of a residual intraabdominal mass in an 8-year-old male patient who was treated for Burkitt lymphoma. An 8-year-old male patient who had been diagnosed with Burkitt lymphoma underwent abdominal computerized tomography for evaluation after chemotherapy. An approximately 2.5 cm mass in the right lower quadrant of the abdomen was detected, and laparoscopic excision of the mass was planned. During the operation, it was noticed that the appendix (adjacent to the mass) was golden yellow in color and abnormal in appearance, so a synchronous appendectomy was performed. The pathology result of the mass was compatible with Burkitt lymphoma. Microscopic examination of the appendix revealed that the columnar surface epithelium had eroded and been replaced by fibrin and cell debris. Inflammatory cell infiltration rich in foamy histiocytes as well as lymphocytes and sparse neutrophils that form destructive aggregates was observed in all appendiceal layers. The final diagnosis of the appendectomy specimen was compatible with XGA. In very few XGA cases, the appendix is described as bright yellow or golden yellow. The diagnosis is usually made by the pathological examination after surgery. Though the diagnosis was made postoperatively in our case, there is now, for the first time in the literature, a view of the golden yellow color of XGA taken from an intraoperative video clip.

Burkitt lenfomalý pediatrik bir hastada intraperitoneal "altýn sarýsý": Ksantogranülomatöz apandisit

Ksantogranülomatöz inflamasyon, nadir görülen bir kronik inflamatuar reaksiyondur. Pediatrik yaþ grubunda apendiks tutulumu oldukça nadirdir. Burkitt lenfoma tedavisi gören 8 yaþýndaki erkek hastada rezidüel karýn içi kitle eksizyonu sýrasýnda tesadüfen saptanan ksantogranülomatöz apandisit (XGA) olgusunu sunuyoruz. Burkitt lenfoma tanýsý konulan 8 yaþýndaki erkek hastaya kemoterapi sonrasý deðerlendirme için karýn bilgisayarlý tomografisi çekildi. Karýn sað alt kadranda yaklaþýk 2,5 cm'lik kitle saptandý ve kitlenin laparoskopik eksizyonu planlandý. Ameliyat sýrasýnda apendiksin (kitleye komþu) altýn sarýsý renginde ve anormal görünümde olduðu fark edildiðinden senkron apendektomi yapýldý. Kitlenin patoloji sonucu Burkitt lenfoma ile uyumluydu. Apendiksin mikroskobik incelemesi, kolumnar yüzey epitelinin aþýndýðýný ve yerini fibrin ve hücre döküntüsü ile deðiþtirdiðini ortaya koydu. Tüm apendiks tabakalarýnda köpüksü histiyositler ve lenfositler ve yýkýcý agregatlar oluþturan seyrek nötrofillerden zengin inflamatuar hücre infiltrasyonu gözlendi. Apendektomi spesmeninin kesin tanýsý XGA ile uyumluydu. Çok az sayýda XGA vakasýnda, apendiks parlak sarý veya altýn sarýsý olarak tanýmlanýr. Taný genellikle ameliyat sonrasý patolojik inceleme ile konur. Olgumuzda taný postoperatif olarak konmasýna raðmen, literatürde ilk kez XGA'nýn altýn sarýsý renginin intraoperatif çekilmiþ görüntüsü bulunmaktadýr. (NCI-2022-8-3)