Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease?

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It is a rare inflammatory process, which has been more frequently described in chronic pyelonephritis and cholecystitis. Xanthogranulomatosis usually triggers a large distortion of the affected organ, which is secondary to the severe inflammatory response that characterizes this type of lesion. Only a few cases of xanthogranulomatous salpingo-oophoritis have been published to date. Here, we report the case of a xanthogranulomatous salpingo-oophoritis in a patient with endometriosis, suffering from chronic pelvic pain and long-standing infertility. The association between endometriosis and xanthogranulomatous inflammation is extremely rare and can possibly represent a severe histologic expression of this common disorder." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/9-94", "name": "Case Report: Xanthogranulomatous salpingo-oophoritis associated to..." } } ] } Home Browse Case Report: Xanthogranulomatous salpingo-oophoritis associated to... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Portela Carvalho A, Costa Braga A and Ferreira H. Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.12688/f1000research.22206.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] Ana Portela Carvalho https://orcid.org/0000-0002-1311-7035 1 , Ana Costa Braga 2 , Hélder Ferreira 3 Ana Portela Carvalho https://orcid.org/0000-0002-1311-7035 1 , Ana Costa Braga 2 , Hélder Ferreira 3 PUBLISHED 07 Feb 2020 Author details Author details 1 Department of Obstetrics and Gynecology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal 2 Department of Pathology, Centro Hospitalar do Porto, Porto, Portugal 3 Department of Gynecology, Centro Hospitalar do Porto, Porto, Portugal Ana Portela Carvalho Roles: Conceptualization, Data Curation, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Ana Costa Braga Roles: Data Curation, Investigation, Writing – Original Draft Preparation Hélder Ferreira Roles: Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Endometriosis collection. Abstract Xanthogranulomatous inflammation is characterized by the presence of foamy histiocytes associated with other inflammatory cells like lymphocytes, plasma cells and neutrophils. It is a rare inflammatory process, which has been more frequently described in chronic pyelonephritis and cholecystitis. Xanthogranulomatosis usually triggers a large distortion of the affected organ, which is secondary to the severe inflammatory response that characterizes this type of lesion. Only a few cases of xanthogranulomatous salpingo-oophoritis have been published to date. Here, we report the case of a xanthogranulomatous salpingo-oophoritis in a patient with endometriosis, suffering from chronic pelvic pain and long-standing infertility. The association between endometriosis and xanthogranulomatous inflammation is extremely rare and can possibly represent a severe histologic expression of this common disorder. READ ALL READ LESS Keywords salpingitis, endometriosis, infertility, xanthogranulomatous salpingo-oophoritis Corresponding Author(s) Ana Portela Carvalho ( [email protected] ) Close Corresponding author: Ana Portela Carvalho Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2020 Portela Carvalho A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Portela Carvalho A, Costa Braga A and Ferreira H. Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.12688/f1000research.22206.1 ) First published: 07 Feb 2020, 9 :94 ( https://doi.org/10.12688/f1000research.22206.1 ) Latest published: 07 Feb 2020, 9 :94 ( https://doi.org/10.12688/f1000research.22206.1 ) Introduction Xanthogranulomatous salpingo-oophoritis (XGSO) is an uncommon form of salpingitis, which is associated with a prominent acute and chronic inflammatory infiltrate with admixed foamy histiocytes 1 – 4 . The presence of this xanthogranulomatous inflammation has been described in several organs, most commonly in kidney or gallbladder, in association with chronic pyelonephritis or cholecystitis, respectively 1 . It is, however, an extremely rare finding in pelvic organs. XGSO has most commonly been associated with pelvic inflammatory disease, but it has also been described in the presence of intrauterine contraceptive devices, extensive endometriosis, ineffective antibiotherapy, abnormalities in lipid metabolism and with the administration of contrast agents 1 – 5 . Few cases of XGSO in patients with leiomyomata have also been published 1 , 4 , 6 . Subclinical bacterial infection seems to intervene and several agents have been implicated, such as Actinomyces , Staphylococcus aureus , Enterococcus faecalis , Escherichia coli , Staphylococcus viridans , Bacteroides fragilis , Candida glabrata and Group B Streptococci 1 . Non-infectious causes have also been pointed. Nevertheless, the aetiology of XGSO remains unknown. Patients with XGSO usually present with signs of pelvic inflammatory disease, notably, pelvic pain, fever and abnormal bleeding. Treatment with antibiotics and/or surgery is required and the diagnosis of this condition is only possible after histological examination 1 , 2 . The differential diagnosis includes: pseudoxanthomatous salpingitis and granulomatous salpingitis. The presence of acute and chronic inflammatory infiltrate differentiates XGSO from pseudoxanthomatous salpingitis, which is characterized by xanthoma cells and pigment without prominent inflammatory component, and from granulomatous salpingitis, where granulomas are present 2 , 3 . Here, we report the case of a XGSO in a patient with chronic pelvic pain and infertility associated with endometriosis. Case report A 35-year-old woman, with no other relevant previous medical or surgical history, presented with 6 years of primary infertility and severe dysmenorrhea and dyspareunia for nearly a year. No other symptoms were described, like dyschezia, dysuria or abnormal vaginal bleeding. The patient had been previous diagnosed with stage III pelvic endometriosis. This diagnosis was histologically established after two abdominal diagnostic laparoscopies in the context of the infertility evaluation. In the last surgery, a left side salpingectomy and adhesiolysis were performed, with limited post-operative improvement. The patient was then referred to our Chronic Pelvic Pain Unit due to clinical worsening. On pelvic examination, a painful area located at the right uterosacral ligament was identified by bimanual exam, without pelvic masses. No other physical abnormalities were detected. A pelvic transvaginal ultrasonography was performed, identifying a large uterus with sonographic signs of adenomyosis. Magnetic resonance imaging showed an hyposignal at T1 and T2 sequences, suggestive of an endometriotic infiltration lesion at the right uterosacral ligament location. This finding correlated with the painful area detected at bimanual exam. Taking in consideration these clinical and imagiological findings, it was decided to perform a laparoscopy. Several adhesions between the uterus and the anterior rectum were identified. The right Fallopian tube was attached to a 2cm nodule in the right ovarium, which was highly suggestive of severe endometriotic infiltration ( Figure 1 and Figure 2 ). In addition to extensive adhesiolysis, a right salpingectomy and oophorectomy were also performed. Figure 1. Right Fallopian tube. Figure 2. Right Fallopian tube, with an inflammatory aspect suggestive of severe endometriotic infiltration. The right fallopian tube was 3.9cm in length, 0.4 cm in diameter and had a golden yellowish colour. The lumen was dilated, with thickened plicae and wall. The serosal surface was irregular, suggesting focal bilateral adhesions. The ovarian mass consisted of an irregular brown to yellowish nodule of tissue with 2cm of diameter. Both the fallopian tissue and the ovarian nodule were paraffin embedded and haematoxylin-eosin stained slides were examined. Histopathological examination of the fallopian tube showed abundant infiltration of the lamina propria by foamy histiocytes mixed with some inflammatory cells, including lymphocytes, plasma cells and occasional neutrophils, and there was no intervening stroma, conditioning tightly packing of the fallopian tube plicae. The histiocytes were intimately contiguous to the muscle wall and the subserosa of the fallopian tube and there was serosa fibrosis, with appearance of focal adhesions ( Figure 3 – Figure 7 ). The histiocytes appeared to contain abundant lipid material. Red cell extravasation was identified throughout the lesion. A similar finding was present in the ovarian nodule, where this pattern of inflammation was in close relation to normal ovarian tissue. No microorganisms were identified using periodic acid–Schiff, methenamine silver, acid-fast bacilli and Gram stains. Immunohistochemical stain was performed on paraffin-embedded sections and demonstrated strong CD68 staining in foamy histiocytes ( Figure 8 ). No pigments, multinucleated giant cells, granulomas or foci of endometriosis were present in both specimens. The fallopian tube epithelium has reactive aspect, without prolifferative foci. These findings were diagnostic of XGSO. Figure 3. Fallopian tube architecture is distorted with infiltration of lamina propria and muscle wall by histiocytes. Figure 4. Fallopian tube muscle wall is disrupted by abundant infiltration of histiocytes and other inflammatory cells. Figure 5. This mixed inflammatory infiltrate distinguishes this entity from the pseudoxanthomatous salpingitis. Figure 6. Infiltration of lamina propria by foamy histiocytes and other inflammatory cells without intervening stroma. Figure 7. Infiltration of Fallopian tube lamina propria by abundant foamy histiocytes, lymphocytes and occasional neutrophils. Figure 8. CD68 immunostain in fallopian tissue demonstrates strong staining in foamy histiocytes. This patient had a significant symptomatic improvement after surgical treatment with sustained clinical response. A close follow-up with regular gynaecological appointments was performed, and no symptomatic recurrence, nor surgical adverse outcomes were detected to date. Discussion Endometriotic lesions are characterized by the presence of blood and endometrial shedding, representing a favourable trigger for the development of chronic inflammation and fibrosis. Classically, this disorder causes pelvic dysfunction and anatomical distortion that both lead to chronic pelvic pain and infertility. The pathologic finding of xanthogranulomatous inflammation may represent a severe form of endometriotic lesions, which could explain the recurrence of symptoms in this patient. Idrees et al. described a progressive spectrum of pathologic changes, from pure endometriosis to mixed endometriotic and xanthogranulomatous inflammation, and finally to only XGSO lesions 2 . The endometrioid implant shedding and the chronic inflammatory process characteristic of endometriosis could explain the xanthomatous process and the accumulation of excessive foamy histiocytes 2 . In this case, we observed a complete replacement of the endometriotic tissue, which was previously documented in prior surgeries, by foamy histiocytes. The current finding of a destructive xanthogranulomatous inflammatory process, in the absence of endometriotic foci , make us speculate that, probably, endometriosis reached a “burnout phase”, as postulated by other authors 2 . Moreover, no other predisposing conditions to the development of XGSO were identified. In conclusion, a long history of histologically documented endometriosis with multiple previous surgical treatments may lead to the development of a chronic exaggerated inflammatory response, as found in XGSO. A xanthogranulomatous inflammation may represent a rare but aggressive expression of such a common disorder, as is endometriosis. Consent Written informed consent for publication of their clinical details and images was obtained from the patient. Data availability All data underlying the results are available as part of the article and no additional source data are required. Faculty Opinions recommended References 1. Gray Y, Libbey NP: Xanthogranulomatous salpingitis and oophoritis: a case report and review of the literature. Arch Pathol Lab Med. 2001; 125 (2): 260–3. PubMed Abstract 2. Idrees M, Zakashansky K, Kalir T: Xanthogranulomatous salpingitis associated with fallopian tube mucosal endometriosis: a clue to the pathogenesis. Ann Diagn Pathol. 2007; 11 (2): 117–21. PubMed Abstract | Publisher Full Text 3. Furuya M, Murakami T, Sato O, et al. : Pseudoxanthomatous and xanthogranulomatous salpingitis of the fallopian tube: a report of four cases and a literature review. Int J Gynecol Pathol. 2002; 21 (1): 56–9. PubMed Abstract | Publisher Full Text 4. Howey JM, Mahe E, Radhi J: Xanthogranulomatous salpingitis associated with a large uterine leiomyoma. Case Rep Med. 2010; 2010 : 970805. PubMed Abstract | Publisher Full Text | Free Full Text 5. Lavoué V, Vigneau C, Duros S, et al. : Which Donor for Uterus Transplants: Brain-Dead Donor or Living Donor? A Systematic Review. Transplantation. 2017; 101 (2): 267–73. PubMed Abstract | Publisher Full Text 6. Abeysundara PK, Padumadasa GS, Tissera WGM, et al. : Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction. J Obstet Gynaecol Res. 2012; 38 (8): 1115–7. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Feb 2020 ADD YOUR COMMENT Comment Author details Author details 1 Department of Obstetrics and Gynecology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal 2 Department of Pathology, Centro Hospitalar do Porto, Porto, Portugal 3 Department of Gynecology, Centro Hospitalar do Porto, Porto, Portugal Ana Portela Carvalho Roles: Conceptualization, Data Curation, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Ana Costa Braga Roles: Data Curation, Investigation, Writing – Original Draft Preparation Hélder Ferreira Roles: Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 07 Feb 2020, 9:94 https://doi.org/10.12688/f1000research.22206.1 Copyright © 2020 Portela Carvalho A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Portela Carvalho A, Costa Braga A and Ferreira H. Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.12688/f1000research.22206.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 07 Feb 2020 Views 0 Cite How to cite this report: Kalkan Ü. Reviewer Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r96889 ) The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-96889 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Nov 2021 Üzeyir Kalkan , Department of Obstetrics and Gynecology, Koç University, Istanbul, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.24491.r96889 This case report provided a new case of a rare pathology of fallopian tube diagnosed as XGSO. The clinical history, histologic findings and quality of macro and micro images are well documented and presented. Although the title is very attractive, ... Continue reading READ ALL This case report provided a new case of a rare pathology of fallopian tube diagnosed as XGSO. The clinical history, histologic findings and quality of macro and micro images are well documented and presented. Although the title is very attractive, the conclusions do not strongly support this attraction in this case report. In XGSO, usually a clinical history of pyometra or PID exists (Furuya et al. (2002 1 )). In this case, there is no data represented that excludes a history of PID. Also, a clear indication of left salpingectomy which was performed in the last surgery is not reported. Was it due to a pyosalpinx/ hydrosalpinx? The pathologic report of left salpingectomy (if accessible) may add to the case report. Usually, pseudoxanthomatous salpingitis is associated with endometriosis (Furuya et al. (2002 1 ), Seidman et al. (2015 2 )), and XGSO is rarely associated with endometriosis. In this case, no pigments, multinucleated giant cells, granulomas, or foci of endometriosis were present in the specimens and this mixed inflammatory infiltrate distinguished from the pseudoxanthomatous salpingitis. However, evidence of endometriosis in associated with XGSO by histologic or laparoscopic findings is not shown or documented. The cause of this XGSO may not definitively be claimed that it is due to endometriosis. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Furuya M, Murakami T, Sato O, Kikuchi K, et al.: Pseudoxanthomatous and xanthogranulomatous salpingitis of the fallopian tube: a report of four cases and a literature review. Int J Gynecol Pathol . 2002; 21 (1): 56-9 PubMed Abstract | Publisher Full Text 2. Seidman JD, Woodburn R: Pseudoxanthomatous salpingitis as an ex vivo model of fallopian tube serous carcinogenesis: a clinicopathologic study of 49 cases. Int J Gynecol Pathol . 2015; 34 (3): 275-80 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: endometriosis, minimally invasive surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kalkan Ü. Reviewer Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r96889 ) The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-96889 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Wei JJ. Reviewer Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r83543 ) The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-83543 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Apr 2021 Jian-Jun Wei , Department of Pathology, Northwestern University, Chicago, IL, 60611, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.24491.r83543 This case report provided a new case of fallopian tube XGSO in a 35 yrs old women. The clinical history, image and histologic findings were well presented. However, the title and major conclusions are not well supported by this case ... Continue reading READ ALL This case report provided a new case of fallopian tube XGSO in a 35 yrs old women. The clinical history, image and histologic findings were well presented. However, the title and major conclusions are not well supported by this case report. Authors concluded that this XGSO was a severe histologic expression of endometriosis based on clinical history. The presented evidences in supporting such connection seems to be lacking or not presented. XGSO can be related to many different diseases (Int J Gynecol Pathol Sep;39(5):468-472) 1 . Endometriosis is one of possible cause. Evidence of endometriosis in associated with XGSO by histologic or laparoscopic findings was not shown or documented. The cause of this XGSO may be unknown. Figures 3-7 are repetitive can be reduced while low power view of configuration of XGSO in fallopian tube should be added. Author speculated a burnout phase of endometriosis for this XGSO. this can be proved by adding CD10 stain to highlight the rim or residual endometrial stromal cells even in a "Burnout phase" of endometriosis. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Chiesa-Vottero A: Xanthogranulomatous Salpingitis. Int J Gynecol Pathol . 2020; 39 (5): 468-472 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: gynecologic pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Wei JJ. Reviewer Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r83543 ) The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-83543 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Feb 2020 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 07 Feb 20 read read Jian-Jun Wei , Northwestern University, Chicago, USA Üzeyir Kalkan , Koç University, Istanbul, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2021 Kalkan Ü. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Nov 2021 | for Version 1 Üzeyir Kalkan , Department of Obstetrics and Gynecology, Koç University, Istanbul, Turkey 0 Views copyright © 2021 Kalkan Ü. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report provided a new case of a rare pathology of fallopian tube diagnosed as XGSO. The clinical history, histologic findings and quality of macro and micro images are well documented and presented. Although the title is very attractive, the conclusions do not strongly support this attraction in this case report. In XGSO, usually a clinical history of pyometra or PID exists (Furuya et al. (2002 1 )). In this case, there is no data represented that excludes a history of PID. Also, a clear indication of left salpingectomy which was performed in the last surgery is not reported. Was it due to a pyosalpinx/ hydrosalpinx? The pathologic report of left salpingectomy (if accessible) may add to the case report. Usually, pseudoxanthomatous salpingitis is associated with endometriosis (Furuya et al. (2002 1 ), Seidman et al. (2015 2 )), and XGSO is rarely associated with endometriosis. In this case, no pigments, multinucleated giant cells, granulomas, or foci of endometriosis were present in the specimens and this mixed inflammatory infiltrate distinguished from the pseudoxanthomatous salpingitis. However, evidence of endometriosis in associated with XGSO by histologic or laparoscopic findings is not shown or documented. The cause of this XGSO may not definitively be claimed that it is due to endometriosis. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Furuya M, Murakami T, Sato O, Kikuchi K, et al.: Pseudoxanthomatous and xanthogranulomatous salpingitis of the fallopian tube: a report of four cases and a literature review. Int J Gynecol Pathol . 2002; 21 (1): 56-9 PubMed Abstract | Publisher Full Text 2. Seidman JD, Woodburn R: Pseudoxanthomatous salpingitis as an ex vivo model of fallopian tube serous carcinogenesis: a clinicopathologic study of 49 cases. Int J Gynecol Pathol . 2015; 34 (3): 275-80 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise endometriosis, minimally invasive surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Kalkan Ü. Peer Review Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r96889) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-96889 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2021 Wei J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Apr 2021 | for Version 1 Jian-Jun Wei , Department of Pathology, Northwestern University, Chicago, IL, 60611, USA 0 Views copyright © 2021 Wei J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report provided a new case of fallopian tube XGSO in a 35 yrs old women. The clinical history, image and histologic findings were well presented. However, the title and major conclusions are not well supported by this case report. Authors concluded that this XGSO was a severe histologic expression of endometriosis based on clinical history. The presented evidences in supporting such connection seems to be lacking or not presented. XGSO can be related to many different diseases (Int J Gynecol Pathol Sep;39(5):468-472) 1 . Endometriosis is one of possible cause. Evidence of endometriosis in associated with XGSO by histologic or laparoscopic findings was not shown or documented. The cause of this XGSO may be unknown. Figures 3-7 are repetitive can be reduced while low power view of configuration of XGSO in fallopian tube should be added. Author speculated a burnout phase of endometriosis for this XGSO. this can be proved by adding CD10 stain to highlight the rim or residual endometrial stromal cells even in a "Burnout phase" of endometriosis. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Chiesa-Vottero A: Xanthogranulomatous Salpingitis. Int J Gynecol Pathol . 2020; 39 (5): 468-472 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise gynecologic pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Wei JJ. Peer Review Report For: Case Report: Xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? [version 1; peer review: 2 approved with reservations] . F1000Research 2020, 9 :94 ( https://doi.org/10.5256/f1000research.24491.r83543) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/9-94/v1#referee-response-83543 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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