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

Nancy Thind, Moneet Walia, P. John, Priya Jindal, Devika Khatri
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(6) , pp. 2221–2224 · doi:10.18203/2320-1770.ijrcog20261634 · W7162655649
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A 40-year-old woman with endometriosis presented with a tubo-ovarian mass mimicking malignancy, which histopathology confirmed as pseudoxanthomatous salpingitis associated with ovarian endometriosis.

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This case report describes a 40-year-old nulligravida with a history of endometriosis who presented with an acute abdomen and was initially suspected to have a tubo-ovarian malignancy due to complex imaging findings and elevated CA-125 levels. Intraoperative examination revealed a mass containing chocolate-colored fluid, and subsequent histopathology confirmed pseudoxanthomatous salpingitis associated with ovarian endometriosis rather than cancer. The authors emphasize that this rare benign inflammatory condition can mimic malignancy radiologically and clinically, creating a significant diagnostic challenge for clinicians. This paper is centrally about endometriosis — specifically illustrating how it is associated with pseudoxanthomatous salpingitis, which masquerades as a malignant tubo-ovarian mass.

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Abstract

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.
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Pseudoxanthomatous salpingitis masquerading as a tubo-ovarian malignancy in a patient with endometriosis: a rare case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20261634Keywords: Pseudoxanthomatous salpingitis, Hemosiderin, Endometriosis, CA-125, Tubo-ovarian MassAbstract 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. Metrics References Limaiem F, Halouani A, Dimassi K. Pseudoxanthomatous salpingitis: An uncommon lesion of the fallopian tube. Clin Case Rep. 2022;10(U):eG31U. DOI: https://doi.org/10.1002/ccr3.6319 Clement PB. Diseases of the peritoneum. Blaustein’s Pathology of the Female Genital Tract. 6th ed. New York: Springer. 2011;649-50. Sternberg WH, Antonioli DA. Pigmentosis tubae (pseudoxanthomatous salpingitis). Arch Pathol Lab Med. 1977;101(9):460-2. Pradhan D, Mohanty SK. Pseudoxanthomatous salpingitis associated with endometriosis: a diagnostic pitfall mimicking malignancy. J Obstet Gynaecol Res. 2016;42(11):1605-8. Clement PB, Young RH. Non-neoplastic lesions of the fallopian tube. Atlas of Gynecologic Surgical Pathology. 2nd ed. Philadelphia: Saunders Elsevier. 2008;233-5. DOI: https://doi.org/10.1016/B978-1-4160-2972-4.50011-8 Zaloudek C, Norris HJ. Mesothelial and inflammatory lesions of the fallopian tube. Am J Surg Pathol. 1984;8(8):597-606.

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