Xanthogranulomatous osteomyelitis

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Xanthogranulomatous osteomyelitis

Xanthogranulomatous osteomyelitis (XO) is a peculiar aspect of osteomyelitis characterized by prevalent histiocytic infiltrate and foamy macrophage clustering.[1]


The granulomatous tissue largely comprises foam cells of monocyte/macrophage origin positive for KP1, HAM56, CD11b and CD68. Neutrophils, hemorrhagic foci and numerous plasma cells are additional findings.[2][3][4][5] Staphylococcus aureus was isolated in the case reported by Kamat et al.[5] A delayed type hypersensitivity reaction in cell-mediated immunity has been suggested in this type of infiltrate that is composed of macrophages and T cells.[3] T cells are represented by a mixture of CD4+ and CD8+ lymphocytes. Macrophages and lymphocytes show marked expression of HLA-DR antigen.[6] Arguably XO is the bone localization of the xanthogranulomatous process occurring in several other locations.[2]


As of 2011 five cases had been reported, involving rib, tibial epiphysis, ulna, distal tibia and femur. Young individuals are prevalently affected but one case involved a 50-year-old woman. Pain, swelling of possibly long duration, fever and increased ESR are some of the main clinical findings. X-ray examination shows lytic foci with sclerotic margins.[2][3][4][5] A neoplastic process can be suspected.



  1. ^ Rosai J(2004). Rosai and Ackerman's Surgical Pathology. Philadelphia, Mosby, p. 2142.
  2. ^ a b c Cozzutto C (1984) Xanthogranulomatous osteomyelitis. Arch Pathol Lab Med 108:973-976.
  3. ^ a b c Vankalakunti M, Saikia UN, Mathew M, Kang M (2007). Xanthogranulomatous osteomyelitis of ulna mimicking a neoplasm. World J Surg Oncol 5(46):1-4.
  4. ^ a b Kashani MM, Zakerian BZ, Shayan K, Riyasi F (2010). Xanthogranulomatous osteomyelitis of femur. Iran J Orthop Surg 8(4):187-190.
  5. ^ a b c Kamat G, Gramapuroit V, Shettar C, Myageri A(2011). Xanthogranulomatous osteomyelitis presenting as swelling in right tibia. Case report. Case Rep Pathol, in press.
  6. ^ Nakashiro S, Fujivara S, Harada S, Hisatsugu T, Watanabe T (1995). Xanthogranulomatous cholecystitis. Cell composition and possible pathogenetic role of cell-mediated immunity.Pathol Res Pract 183:395-482.