A benign illusion: elevated CA 19-9 and bilateral xanthogranulomatous salpingitis hiding behind pelvic endometriosis

A benign illusion: elevated CA 19-9 and bilateral xanthogranulomatous salpingitis hiding behind pelvic endometriosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20264028Keywords: Xanthogranulomatous salpingitis, Pelvic endometriosis, Asymptomatic adnexal mass, Tubo-ovarian mass, Intraoperative frozen sectionAbstract Xanthogranulomatous salpingitis (XGS) is a rare, benign, chronic inflammatory tubal condition that frequently mimics advanced malignancy, and its concurrent presentation with endometriosis is exceptionally rare. We present the case of an asymptomatic 44-year-old female who was found to have a complex tubo-ovarian mass and an elevated CA 19-9 during a routine solid organ donor evaluation. Suspecting malignancy, diagnostic laparoscopy was performed. Crucially, intraoperative frozen section analysis revealed benign pathology, prompting a fertility-sparing surgical approach involving left mass excision, right salpingectomy, and endometriosis resection. Final histopathology unexpectedly confirmed bilateral XGS with concurrent pelvic endometriosis. This case highlights that XGS can develop entirely silently alongside endometriosis, likely driven by chronic hemorrhage rather than bacterial infection. Intraoperative pathological evaluation is imperative to prevent the radical oncological overtreatment of complex, adherent adnexal masses. Metrics References Gray Y, Libbey NP. Xanthogranulomatous salpingitis and oophoritis. Arch Pathol Lab Med. 2001;125(2):260-3. DOI: https://doi.org/10.5858/2001-125-0260-XSAO Abeysundara PK, Padumadasa GS, Tissera WGM, Wijesinghe PS. Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction. J Obstet Gynaecol Res. 2012;38(7):1115-7. DOI: https://doi.org/10.1111/j.1447-0756.2011.01834.x Portela Carvalho A, Costa Braga A, Ferreira H. Case report: xanthogranulomatous salpingo-oophoritis associated to endometriosis – are these different histologic expressions of the same disease? F1000Res. 2020;9:94. DOI: https://doi.org/10.12688/f1000research.22206.1 Punia RS, Aggarwal R, Amanjit, Mohan H. Xanthogranulomatous oophoritis and salpingitis: late sequelae of inadequately treated staphylococcal PID. Indian J Pathol Microbiol. 2003;46(1):80-1. 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. DOI: https://doi.org/10.1016/j.anndiagpath.2005.12.004 Downloads Published How to Cite Issue Section License Copyright (c) 2026 Rahul Manchanda, Yash Bahuguna, Pragya Verma This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.