Xanthogranulomatous endometritis with unilateral salpingo-oophoritis in a postmenopausal woman masquerading as a malignancy.

Xanthogranulomatous endometritis (XGE) is a rare pathological entity which is characterised by sheets of foamy histiocytes and lymphoplasmacytic infiltrates. This condition can mimic endometrial carcinoma. We report a case, clinically suspected as carcinoma of the endometrium/ovary, which was diagnosed as XGE with left salpingo-oophoritis on histopathology.

Xanthogranulomatous salpingo-oophoritis presenting as an ovarian tumour.

Xanthogranulomatous salpingo-oophoritis (XGSO) is an exceptionally rare entity. Its clinical manifestations and imaging modalities can mimic benign and malignant adnexal diseases, making it difficult to diagnose. Here we report a case of XGSO in a young woman who was operated with suspicion of a borderline ovarian tumour. Preoperative diagnosis of XGSO should be considered to avoid radical surgical treatment, especially in young patients.

Case Of Xanthogranulomatous Oophoritis.

Xanthogranulomatous inflammation is characterized by destruction of the tissues of the organ involved and replacement by chronic inflammatory cells such as lymphocytes, plasma cells, occasional neutrophils with or without multinucleated or Touton giant cells. Exact aetiology is not known but the theory of infection with organisms like Proteus, E coli, and Bacteroides fragilis is most popular. Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity.

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values.

OBJECTIVE: To assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy. MATERIALS AND METHODS: Patients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis. RESULTS: The mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10(-3) mm(2)/s vs. 2.42 ± 0.38 × 10(-3) mm(2)/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10(-3) mm(2)/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10(-3) mm(2)/s vs.1.18 ± 0.36 × 10(-3) mm(2)/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively. CONCLUSIONS: DW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.

Pelvic inflammatory disease: diagnosis and treatment in the emergency department [digest].

Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed. [Points & Pearls is a digest of Emergency Medicine Practice].

Xanthogranulomatous Oophoritis Presenting as an Adnexal Mass and Bowel Obstruction. A Case Report.

BACKGROUND: Xanthogranulomatous inflammation of the female genital tract is a rare entity. When the gynecological organs are affected, it is particularly unusual for xanthogranulomataus inflammation to involve only the ovary. CASE: A 45-year-old woman with an intrauterine device, long-term exposure to nicotine, and hyperlipidemia presented with an adnexal mass and bowel obstruction. She underwent 2 exploratory laparotomies, ureteral stent placement, left salpingooophorectomy, and rectosigmoid resection with end colostomy. Pathology revealed xanthogranulomatous oophoritis without involvement of the associated fallopian tube. CONCLUSION: The synergistic effects of intrauterine device use, abnormal lipid levels, and long-term nicotine exposure may have contributed to the development of this patient's condition. Knowledge of xanthogranulomatous inflammation is essential to avoid misdiagnosis of malignancy and excessive surgical intervention.

Xanthogranulomatous oophoritis mimicking malignancy: a diagnostic dilemma.

Xanthogranulomatous inflammation is a chronic condition in which the affected organ is replaced by lipid-filled macrophages with plasma cells, lymphocytes and neutrophils. It is very rare in the ovaries. A case of xanthogranulomatous oophoritis in a premenopausal multiparous woman presenting with abnormal uterine bleeding and adnexal mass whose clinical and imaging findings suggested malignancy is reported.

Autoimmune oophoritis: a rarely encountered ovarian lesion.

Autoimmune oophoritis is a rare disorder causing ovarian failure clinically characterized by amenorrhea and infertility. It often occurs in a setting of autoimmune polyendocrine syndromes. A 38-year-old female presented with a 3 years history of secondary amenorrhea. She was on treatment for Hashimoto's thyroiditis and Addison's disease. The ovaries were cystic and histologically featured by folliculotropic lymphoplasmacytic inflammatory infiltrate concentrated in the theca interna layer of developing follicles, but sparing the primordial follicles.

[Spontaneous renal forniceal rupture with suspicious ovarian mass]. / Urétéro-hydronéphrose avec rupture du fornix sur masse ovarienne suspecte.

Extravasation of urine following rupture of the renal fornix is a rare complication mostly caused by obstruction secondary to distal ureteric stones. This 35-year-old woman was referred with back pain. Her CT scan revealed rupture of the renal fornix secondary to a pelvic mass. Laparoscopy subsequently confirmed this to be an ovarian abscess. We report the first case of spontaneous renal forniceal rupture secondary to pelvic inflammatory disease.

Xanthomatous oophoritis following uterine artery embolisation: successful conservative surgical management with favourable outcome.

Xanthomatous oophoritis is a rare inflammatory condition of the ovaries. We are reporting a case of a 28-year-old woman, who had undergone uterine artery embolisation 4 years ago due to symptomatic focal adenomyosis. After 3 years of embolisation, the patient started having chronic pelvic pain, dysmenorrhoea and polymenorrhagia along with inability to conceive. Abdominal examination showed 16 weeks size mass arising from the pelvis. Ultrasound findings were suggestive of focal adenomyosis and bilateral tubo-ovarian masses. A CT scan report showed cystic enlargement of ovaries showing high-density fluid contents. MRI showed two well-defined, thick-walled, septated, cystic lesions appearing hyperintense on both T1-weighted (T1w) and T2w images with peripheral and septal enhancement. Bilateral abscess walls were excised and the healthy ovarian tissue was left behind during surgery. Histopathology of the cyst wall showed xanthomatous oophoritis. After the conservative surgery, she received three doses of goserelin. She conceived spontaneously thereafter and delivered a healthy term baby.

Protein-losing enteropathy and premature ovarian failure in a young woman with systemic lupus erythematosus.

Protein-losing enteropathy (PLE) and autoimmune oophoritis are unusual manifestations of systemic lupus erythematosus (SLE). Autoimmune oophoritis may result in menstrual disturbance and spontaneous premature ovarian failure. However, there is no validated examination to confirm the diagnosis and it is easily neglected in patients with ovarian insufficiency. A 31-year-old woman with SLE presented with PLE and autoimmune oophoritis during the long course of flares and remissions in her lupus activity. The synchronism implied the association between the two. Moreover, both conditions simultaneously had a good response to cyclosporine A (CsA) therapy.

Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review.

Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.

[Unilateral salpingian and ovarian TB, a rare form of extrapulmonary TB]. / Salpingo--ovarita bacilara unilaterala, forma, rara de tuberculoza extrapulmonara.

TB salpingitis and ovarian TB is a rare association of extrapulmonary tuberculosis, especially when the lesions are not associated with lung involvement. The correct therapy leads to the sterilization of the tuberculosis foci, although the risk of scars and adhesions is high, causing local functional disorders.

Local lymphocytic and epithelial activation in a case of autoimmune oophoritis.

OBJECTIVE: To further define the immunological tissular modifications in premature ovarian failure (POF). METHOD: The patient was followed up for premature ovarian failure and mild endometriosis associated with serum antiovarian antibodies. A laparoscopic ovarian biopsy was decided on to analyze the tissue and support the onset of immunosuppressive therapy. Immunohistochemistry was performed using monoclonal antibodies directed against T cell membrane markers, as well as activation molecules, to define the composition of the cellular infiltrate and the consequences on ovarian tissue. RESULT(S): A dense infiltration of activated T lymphocytes was observed in close contact with follicular epithelium expressing HLA-DR and CD40. CONCLUSION(S): This observation supports the role of cellular immunity in ovarian autoimmunity with features very similar to those reported in murine models and other human autoimmune endocrine pathologies.

Tuboovarian abscess caused by Candida in a woman with an intrauterine device.

Candida infection should be considered in an individual with a pelvic abscess that is unresponsive to conventional antibiotic therapy, particularly in the presence of an intrauterine device. We present a case of a tuboovarian abscess caused by Candida species in a woman with an intrauterine device for >10 years. Surgical intervention followed by antifungal therapy resulted in a favorable outcome.