Xanthogranulomatous Oophoritis Associated With Chronic Endometriosis: A Clinical Observation

BACKGROUND: Xanthogranulomatous oophoritis (XGO) is a rare chronic inflammatory con-dition that can mimic ovarian malignancy both clinically and radiologically. It is characterized by foamy histiocytes and inflammatory infiltrates, often leading to diagnostic challenges. Few cases have been reported in the literature, and even fewer have noted coexistent endometriosis. CASE PRESENTATION: We present a rare case of XGO in a woman with longstanding endometriosis, highlighting its clinical, radiological, and histopathological correlation. We report a case of a 50-year-old post-menopausal woman with a history of chronic pelvic pain and endometriosis who pre-sented with an adnexal mass. Imaging raised suspicion of ovarian neoplasm. The patient underwent staging laparotomy in view of a persistent, complex adnexal mass with solid-cystic components noted on imaging, and a clinical suspicion of ovarian malignancy. Histopathological evaluation of the ovary post-surgery revealed a fibrocollagenous cyst wall, lined by dense chronic inflammatory infiltrates composed predominantly of foamy histiocytes, lymphocytes, plasma cells, and occasional neutro-phils. Sheets of lipid-laden macrophages with abundant granular cytoplasm were characteristic of xanthogranulomatous inflammation. Foci of fibrosis and hemosiderin-laden macrophages were also identified. CONCLUSION: The final diagnosis was Xanthogranulomatous oophoritis in an endometriotic back-ground. XGO should be considered in the differential diagnosis of adnexal masses, particularly in patients with endometriosis. Accurate diagnosis requires histopathology to avoid overtreatment.