Pemphigoid gestationis. Case report

Abstract

Xanthogranulomatous inflammation of the female genital tract is infrequent and is
even rarer in fallopian tubes and ovaries. We present a case of xanthogranulomatous
oophorosalpingitis in a 45-year-old female patient who consulted for left iliac fossa
pain accompanied by fever. Bimanual examination revealed a slightly enlarged uterus
with a firm, non-painful left adnexal mass, adherent to the uterus and with limited
mobility. Transvaginal ultrasound evaluation showed a heterogeneous left ovarian
tumor with thick and irregular walls with multiple septa and internal echoes without
visualization of the ovary. During surgery, dense adhesions were found from the mass
to the pelvic lateral wall, ovarian fossa, and bowel loops. The uterus was displaced by
a thick-walled, grayish-white, cystic left adnexal tumor draining foul-smelling purulent
fluid. The definitive diagnosis was xanthogranulomatous oophorosalpingitis. This
condition is a rare inflammatory process that poses diagnostic dilemmas. Its clinical
manifestations and imaging features may mimic a malignant pelvic neoplasm, so a
high index of suspicion is necessary for its diagnosis, as a differential diagnosis in
patients with complex cystic ovarian tumors. Histopathological examination is the
gold standard for diagnosis.