Pseudoxanthomatous salpingitis masquerading as a tubo-ovarian malignancy in a patient with endometriosis: a rare case report

Pseudoxanthomatous salpingitis (PXS), also known as pigmentosis tubae, is an extremely rare benign inflammatory condition of the fallopian tube characterised by the presence of lipofuscin- and hemosiderin-laden macrophages within the lamina propria. Owing to its gross appearance and radiological findings, it may closely mimic tubo-ovarian malignancy, leading to diagnostic dilemma. We report a case of a 40-year-old nulligravida with a history of endometriosis who presented with acute abdomen and was radiologically diagnosed as a complex ovarian mass with markedly raised CA-125 levels. Intraoperatively, a tubo-ovarian mass with chocolate-coloured fluid was noted. Histopathological examination revealed features consistent with pseudoxanthomatous salpingitis associated with ovarian endometriosis. This case highlights the importance of considering PXS in the differential diagnosis of tubo-ovarian masses, especially in patients with endometriosis, to avoid overtreatment. Early recognition of this rare entity can help avoid overtreatment, especially in fertility-desiring patients.