Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction

Abstract

Xanthogranulomatous inflammation is a rare form of chronic granulomatous inflammation. Bacterial infections, immunosuppression, chronic inflammatory conditions, luminal obstruction, endometriosis, leiomyoma, abnormal lipid metabolism, ineffective antibiotic therapy, ineffective clearance of bacteria by phagocytes and chronic irritation of the urachal remnant have been implicated in the pathogenesis. There are very few reported cases of xanthogranulomatous salpingitis and oophoritis. We present such a case in a 34-year-old female, with primary subfertility for eight years, endometriosis, uterine leiomyoma, type II diabetes mellitus and a history of surgery for endometriosis and fibroids and surgical wound infection, who presented with symptoms of intestinal obstruction. The patient underwent emergency laparotomy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology revealed xanthogranulomatous salpingitis and oophoritis. Chronic inflammation due to inadequate treatment of bacterial infection, coupled with pelvic endometriosis and uterine leiomyoma may have led to xanthogranulomatous salpingitis and oophoritis.

Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

“…In 26 out of 46 reported cases hysterectomy with bilateral salpingooophorectomy was performed. [1][2][3]6,[8][9][10][13][14][15][17][18][19][20][21]24,26,[29][30][31][32]35,39,40 The differential diagnosis of xanthogranulomatous salpingitis and oophoritis includes both non-neoplastic and neoplastic conditions. The non-neoplastic conditions are mainly infections such as tuberculosis and fungal infections and malakoplakia that need to be ruled out by cultural studies and special stains such as periodic acid Schiff stain, gram stain and acid-fast stains.…”

Xanthomatous oophoritis following uterine artery embolisation: successful conservative surgical management with favourable outcome

“…The normal appearing ovarian tissue was spared and involved ovarian pseudotumour was excised. In another similar report, a patient with subfertility had endometriosis and leiomyoma had to undergo hysterectomy with bilateral salpingo-oophorectomy 3. Owing to extensive destruction, cut section of these lesions shows solid, fragile areas with haemorrhage and necrosis in most of the cases 1 8 10 16.…”

“…There are only few reported cases of xanthomatous oophoritis and as the pathology is destructive in nature, the treatment reported in most of the cases is salpingo-oophorectomy 2 3 10–16. Antibiotic therapy has been attempted by some but was unsuccessful in decreasing the size of ovarian mass 16.…”

“…Many organs have been reported to be affected by xanthomatous inflammation like the kidneys, urinary bladder, stomach, bones, testis, epididymis and gall bladder 1. Female genital organ involvement is rare and usually follows pelvic inflammatory disease or endometriosis 2 3. The predisposing factors are necrosis, haemorrhage and obstruction.…”

Surprisingly benign histopathology in a case of malignant looking ovary

“…Premature ovarian failure as rare sequelae of xanthogranulomatous inflammation has also been reported 10 . Cases of xanthogranulomatous inflammation of ovary with ovarian hemangioma 11 , secondary to diverticulitis 12 , as an unusual cause of tuboovarian abscess 1 , association with endometriosis and uterine leiomyoma 13 , association with diabetes mellitus 14 , secondary to talcum powder 15 , presenting as an unusual complication of typhoid 16 and following uterine artery embolization 17 have been reported.…”