A46-year-oldwomanwasadmittedtotheobstetricsandgynecologydepartmentforanabscessin thepouchofDouglas2monthsearlier.Contrast-enhancedcomputedtomography(CT)showeda2.0× 1.5 cm 2 tumor with a contrast-enhancing effect on the appendix root, and lymphadenopathy around the cecumwasalsoseen.Lowergastrointestinalendoscopyshowedareddish,swollenareaaroundtheappendixopeningwithwhitepus.Nofindingssuggestingmalignancywereobtainedonbiopsy.FDG-PETex-aminationshowedaccumulationconsistentwiththemassseenonCT.Thoughappendicealcancercould not be ruled out, laparoscopic ileocolic resection was planned and performed. Pathological examination showedxanthogranulomatousappendicitis.Xanthogranulomatousappendicitisisararediseasethatisdifficulttodistinguishfromappendicealcancer.Thereisnoconsensusonthesurgicalprocedure,anditis necessarytocarefullyselectittakingintoaccountthepatient'sgeneralconditionandwishes.