Challenges in diagnosis and management of xanthogranulomatous salpingo-oophoritis: A rare case

Abstract

Introduction and importance: Xanthogranulomatous inflammation of the female genital tract is a rare condition involving ovarian tubes characterized by chronic inflammation and destruction of pelvic organs, often mimicking pelvic malignancy.

Case presentation: A 37-year-old female with a history of chronic kidney disease, hypertension, and treated pulmonary tuberculosis, presented with lower abdominal fullness, pain, and irregular menstrual cycles.

Clinical discussion: Radiological investigations revealed a significant left adnexal mass, suggesting a tubo-ovarian abscess or neoplastic lesion. Staging laparotomy was performed, and intraoperatively, the mass was found adherent to surrounding organs. A frozen section analysis indicated a benign lesion and a hysterectomy was deferred. Histopathological evaluation confirmed the diagnosis of xanthogranulomatosis salpingo-oophoritis.

Conclusion: This case underscores the importance of considering rare inflammatory conditions in the differential diagnosis of pelvic masses. It highlights the challenges in management, including the risk of extensive surgeries leading to infertility. Thorough investigation and accurate diagnosis are crucial for appropriate management and to minimize unnecessary interventions.

Keywords: Case report; Misdiagnosis; Pelvic malignancy mimic; Tubo-ovarian abscess; Xanthogranulomatous salpingo-oophoritis.

Fig. 1

Ultrasonography (USG). Ultrasonography revealed a midline thick-walled adnexal cyst measuring 11 × 10 cm with internal septation.

Fig. 2

CT-Scan abdomen. CT imaging demonstrated a large left adnexal thick-walled, multiloculated, incomplete septations of 12 × 10 × 11cm, suggestive of a tubo-ovarian abscess or neoplastic lesion.

Fig. 3

Adherent left tubo-ovarian mass observed during laparotomy.

Fig. 4

Histopathologic imaging showing the presence of lipid-laden macrophages and chronic inflammatory cells.