Xanthogranulomatous Endometritis as a Cause of Refractory Inflammation in the Postpartum Period: A Case Report with Pathomorphological Verification and Pathogenetic Analysis

Xanthogranulomatous inflammation of the uterine mucosa is an exceedingly rare pathological condition characterized by the infiltration of the endometrial tissue by foamy histiocytic elements (xanthoma cells) with a variable admixture of associated multinucleated giant cells, other chronic inflammatory cells, and, in some cases, areas of necrosis, calcifications, and hemosiderin granules. Scientific publications providing detailed descriptions of such cases are extremely scarce in the literature, and reported instances are typically associated with challenging clinical diagnosis and management of endometrial carcinoma. A search of available scientific publications revealed no reports detailing this condition in the postpartum period.

The aim of the study was to evaluate the clinical and morphological diagnostic criteria and pathogenetic features of chronic xanthogranulomatous endometritis in a 29-year-old woman during the late puerperium, based on a rare case analysis, with particular reference to their manifestation under conditions of endometrial involutional changes.

Material and methods. A pathomorphological examination was performed on material obtained by vacuum aspiration from the uterine cavity. The analysis included standard hematoxylin and eosin staining, additional histochemical staining using Perl's method (Perls' stain), and immunohistochemical staining with monoclonal antibodies against CD68.

Results. The disease was characterized by resistance to standard antibiotic therapy, and the diagnosis was confirmed morphologically following uterine curettage. The histopathological picture of the endometrium revealed a productive tissue inflammatory reaction featuring an accumulation of foamy histiocytes within the endometrial stroma, intermixed with acute and chronic inflammatory cells, against a background of a persistent endocervical glandular polyp. The article provides an in-depth analysis of the pathogenetic mechanisms of this condition, emphasizing the role of cervical canal obstruction by the endocervical polyp in the morphogenesis of postpartum xanthogranulomatous endometritis. The critical importance of timely histopathological examination for establishing a correct diagnosis and determining an appropriate management strategy for women of reproductive age is underscored.

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