Xanthogranulomatous Salpingo-Oophoritis Mimicking an Ovarian Malignancy – A Series of 3 Cases and Review of Literature

Abstract

Background: Xanthogranulomatoussalpingo-oophoritis is an uncommon form of chronic inflammation in the genitourinary tract. Its symptoms and radiological findings mimic ovarian malignancy or severe pelvic inflammatory disease. Case (s): We describe three cases of xanthogranulomatoussalpingo-oophoritis diagnosed in our hospital and review literature on clinical features and diagnostic pitfalls of this condition. Our first patient is a 45-year-old lady who presented with abdominal pain and fever. The second patient is a 51-year-old lady who presented similarly. The last patient is a 35-year-old lady who chronic pelvic inflammatory disease. From literature, risk factors include endometriosis, leiomyoma, pelvic inflammatory disease, intrauterine copper device (IUCD) in situ and previous surgery. Most patients had abdominal pain, fever and adnexal mass on examination. Most women were treated based on the working diagnosis of malignancy or severe pelvic inflammatory disease. Conclusion: Xanthogranulomatoussalpingo-oophoritis is a rare condition that is often mistaken for ovarian malignancy clinically and radiologically. Oophorectomy is the recommended treatment but most women are “over treated” with staging laparotomies and hysterectomies that render them infertile. The presence of fever, abdominal pain, identifiable risk factors, MRI characteristics and the use of intra-operative frozen-section may aid in the diagnosis.