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

Abstract

SUMMARYXanthomatous oophoritis is a rare inflammatory condition of the ovaries. We are reporting a case of a 28-year-old woman, who had undergone uterine artery embolisation 4 years ago due to symptomatic focal adenomyosis. After 3 years of embolisation, the patient started having chronic pelvic pain, dysmenorrhoea and polymenorrhagia along with inability to conceive. Abdominal examination showed 16 weeks size mass arising from the pelvis. Ultrasound findings were suggestive of focal adenomyosis and bilateral tuboovarian masses. A CT scan report showed cystic enlargement of ovaries showing high-density fluid contents. MRI showed two well-defined, thick-walled, septated, cystic lesions appearing hyperintense on both T1-weighted (T1w) and T2w images with peripheral and septal enhancement. Bilateral abscess walls were excised and the healthy ovarian tissue was left behind during surgery. Histopathology of the cyst wall showed xanthomatous oophoritis. After the conservative surgery, she received three doses of goserelin. She conceived spontaneously thereafter and delivered a healthy term baby. BACKGROUND

Xanthogranulomatous oophoritis mimicking malignancy: a diagnostic dilemma

“…It is very rare in female genital organs and mainly involves endometrium 2. Only a few cases with ovarian involvement have been reported to date 3. Although multiple predisposing factors such as pelvic inflammatory diseases, intrauterine device use, leiomyoma uterus, endometriosis and inappropriate antibiotic intake are attributed to the development of xanthogranulomatous oophoritis, immunocompromised status leading on to chronic destruction of the affected organ, as in this case, has not been described so far.…”

Female Genital Tract Affected by Xanthogranulomatous Inflammation: A Series of Four Cases and Review of Literature

“…PID is the most frequent association, infectious agent isolated was Escherechia coli in most of the cases reported. 3 , 8 Other organisms isolated were Klebsiella, 9 Bacteroides fragilis and Streptococcus mitis . 10 Uterine artery embolization as a causative factor has also been reported.…”

A rare case report of xanthogranulomatous oophoritis with serous cystadenoma in pregnancy

“…The etiopathogenesis of xanthogranulomatous inflammation still remains unclear. Theories like abnormality in lipid metabolism, infection, ineffective antibiotic therapy and ineffective clearance of bacteria by phagocytes are proposed [7] Infection with organisms like Proteus, E coli and Bacteroides fragilis, Actinomyces and Staphylococcus aureus are reported as probable causative organisms in studies [8,9] Uterine artery embolization, gloves dusting powder and altered lipid metabolism are also hypothesized to cause the pathology [10,11,12,13] . Association with inadequately treated pelvic inflammatory disease Endometriosis, Intrauterine device use has also been reported [10] .…”