Xanthogranulomatous Salpingitis Presenting as Pyosalpinx in a Non-Sexually Active Adolescent Girl.

INTRODUCTION: Although pelvic inflammatory disease is seen in sexually active women, it can also be seen in virgin girls. One of the conditions that can develop if not treated appropriately is pyosalpinx. A case of pyosalpinx causing xanthogranulomatous inflammation, a rare type of inflammation, is presented. CASE: A 15-year-old virgin adolescent patient underwent salpingectomy for left pyosalpinx, and the pathology result revealed xanthogranulomatous salpingitis. CONCLUSION: Pelvic inflammatory disease is extremely rare in virgin adolescents and there is usually an underlying anatomic anomaly. No anatomical anomaly was detected in our case, but the detection of E.coli in the abscess fluid culture and the chronic constipation of our patient made us think that the cause of the disease was an ascending infection originating from the gastrointestinal tract.

Diagnostic Value and Clinical Application of Diffusion-Weighted Magnetic Resonance Imaging for Female Pelvic Lesions.

Pelvic inflammatory disease refers to a group of infectious diseases of the female upper genital tract, often caused by ascending infection of vaginitis and cervicitis, causing endometritis, salpingitis, tubo-ovarian abscess, pelvic connective tissue inflammation, and/or pelvic peritonitis. PID is the most common and important infectious disease in nonpregnant women of childbearing age, and inflammation in multiple parts often coexists and affects each other. The functional MRI techniques currently used in pelvic floor muscle injury are magnetic resonance diffusion tensor imaging, T2 mapping, and magnetic resonance elastography. Diffusion tensor imaging is a new imaging and postprocessing technology developed on the basis of magnetic resonance diffusion-weighted imaging. Due to the lack of specificity of clinical symptoms, many subclinical patients are often not detected and diagnosed in time, so it is very difficult to accurately estimate the incidence of PID. This article retrospectively analyzed 72 patients with pelvic inflammatory disease confirmed by surgical pathology from February 2020 to 2022, who had undergone pelvic MRI examination before surgery, including 25 patients with chronic pelvic inflammation (hydrosalpinx), 25 patients with acute pelvic inflammation, and 47 cases (including 21 cases of hydrosalpinx, 19 cases of tubo-ovarian abscess, and 7 cases of pelvic abscess). The age range was 13 to 59 years old. The clinical data and MRI findings were analyzed, the ADC value of the cystic part of the lesion was measured, and the differences in age, maximum diameter of the lesion, thickness of the vessel wall/separation, and the ADC value of the cystic part of chronic and acute pelvic inflammation were compared. In this part of the cases, there were 25 cases of chronic pelvic inflammation and 47 cases of acute pelvic inflammation. The average ADC value of the cystic component of chronic inflammation was significantly higher than that of acute inflammation, which were (2.86 ± 0.20) × 10-3 mm2/s and (1.07 ± 0.38) ×10-3 mm2/s, respectively, P value <0.001.

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.

Recurrent Bilateral Salpingitis in a Sexually Inactive Adolescent: Don't Forget about the Appendix.

BACKGROUND: Salpingitis is an acute inflammation of the fallopian tubes and is extremely uncommon in patients who are sexually inactive or premenarchal. CASE: We describe a 15-year-old sexually inactive patient with recurrent bilateral salpingitis. After the second episode, she underwent an exploratory laparoscopy and was diagnosed with chronic appendicitis. SUMMARY AND CONCLUSION: Appendicular involvement should be kept in mind in recurrent salpingitis episodes, especially if previous imaging studies do not show signs of appendicitis. Imaging studies should be repeated in experienced centers in case of recurrent episodes. Laparoscopy is the gold standard for the diagnosis of salpingitis and can confirm appendicular or other abdominal involvement. Early diagnosis can help to prevent recurrent episodes of salpingitis and thus reduce the risk of sequelae.

Xanthogranulomatous Salpingitis.

There are approximately a dozen cases of xanthogranulomatous salpingitis reported in the literature, mostly as case reports. Thirteen such cases were identified from 2003 to 2018 at our institution. Patient's ages ranged from 21 to 75 yr old (median and mean, 49 yr). Clinical presentations and surgical indications included pelvic inflammatory disease (5 cases), endometrial carcinoma (4 cases), suspicion of ovarian malignancy (1 case), symptomatic fibroids (1 case), endometriosis (1 case), and infertility (1 case). Surgical-pathologic correlation resulted in diagnoses of tubo-ovarian abscess (4 cases), ovarian abscess (2 cases), pyosalpinx (2 cases), and chronic endometritis (2 cases). Of the remaining 3 cases, 2 presented clinically as pelvic inflammatory disease and the other was seen in the context of an endometrial carcinoma. In summary, this case series from a single institution shows that xanthogranulomatous salpingitis is an uncommon form of chronic inflammation that may be diagnosed from reproductive to menopausal age. With one exception, the cases in this series represent pelvic inflammatory disease despite variable clinical presentations. Pseudoxanthomatous salpingitis should be in the differential diagnosis.

A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report.

BACKGROUND: Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria gonorrhea in addition to some Enterobacteriaceae. On the other hand, type 2 diabetes is a disease with a lot of complications such as hyperglycemia, inflammation, and immune disorders. Therefore, patients with type 2 diabetes mellitus have an increased susceptibility to infection especially when glycemic control is poor. CASE PRESENTATION: We experienced a rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus. A 72-year-old Japanese woman with a 10-year history of type 2 diabetes mellitus had symptoms of diarrhea and persistent pain in left lower abdomen. She had mild tenderness to palpation in her abdomen. Inflammation markers were markedly elevated. Her abdominal computed tomography and magnetic resonance imaging on admission revealed a tumor in left side of intrapelvis and we diagnosed her as having pyosalpinx. Pathogenic bacteria were not detected. On admission, her glycemic control was relatively good; in addition, her glycated hemoglobin levels were around 6% for over 1 year. Although pathogenic bacteria were not detected, we started antibiotics therapy. Fourteen days after starting the antibiotics her laboratory data were improved. Three months later, the tumor was markedly smaller compared to that on admission. CONCLUSIONS: We should keep in mind that older patients with type 2 diabetes mellitus are immunocompromised hosts and thereby they could have rare pelvic inflammatory disease such as pyosalpinx even when good glycemic control is obtained for a long period of time.

An incidental finding of chronic salpingitis complications: Tubo-uterine fistula.

OBJECTIVE: Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of the disease ranges from subclinical and asymptomatic infection to severe, lifethreatening illness; squealae include chronic pelvic pain, ectopic pregnancy, and infertility. In this case we report an uncommon complication of pelvic inflammatory disease, a tubo-uterian fistula. Our case was diagnosed by laparoscopy incidentally during assessment of infertility.

Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly.

Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.

Sexually transmitted infections after bereavement - a population-based cohort study.

BACKGROUND: Loss of a loved one has consistently been associated with various health risks. Little is however known about its relation to sexually transmitted infections (STIs). METHODS: We conducted a population-based cohort study during 1987-2012 using the Swedish Multi-Generation Register, including 3,002,209 women aged 10-44 years. Bereavement was defined as death of a child, parent, sibling or spouse (N = 979,579, 33 %). STIs were defined as hospital visits with an STI as main or secondary diagnosis. Poisson regression and negative binomial regression were used to estimate incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) of STIs, comparing incidence rates of women who had experienced loss to those who had not. RESULTS: Bereaved women were at significantly higher risk of nearly all STIs studied. The relative risk of any STI was highest during the first year after loss (IRR: 1.45, 95 % CI: 1.27-1.65) and predominantly among women with subsequent onset of psychiatric disorders after bereavement (IRR: 2.61, 95 % CI: 2.00-3.34). Notably, a consistent excess risk, persisting for over five years, was observed for acute salpingitis (IRR: 1.28, 95 % CI: 1.13-1.44), a severe complication of bacterial STIs. CONCLUSION: These data suggest that women who have experienced bereavement are at increased risk of STIs.

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.

Enterobius Vermicularis-Associated Pelvic Inflammatory Disease in a Child.

BACKGROUND: Enterobius vermicularis is the most highly prevalent intestinal worm in childhood and is generally considered of low pathogenicity. Little is known about the inflammatory complications of the female genital tract induced by E. vermicularis in childhood. CASE: A case of E. vermicularis-associated pelvic inflammatory disease with right salpingitis mimicking acute abdomen due to appendicitis in an 11-year-old girl is presented. CONCLUSION: E. vermicularis-related pelvic inflammatory disease should be included in the differential diagnosis of abdominal pain in children. Increased awareness is necessary to avoid an unnecessary surgery and to choose the correct antibiotic treatment.

Acute Salpingitis in a Nonsexually Active Adolescent.

Acute salpingitis is an uncommon cause of an acute surgical abdomen, especially in an adolescent who is not sexually active. The following is a case of a 12-year-old girl who denied sexual activity, had a remote history of an appendectomy, and a recent diagnosis of a large, right-sided ovarian cyst, who presented with acute abdominal pain, urinary symptoms, and fever. The patient was ill-appearing and progressed to uncompensated septic shock in the emergency department despite aggressive fluid resuscitation and empiric antibiotics. She ultimately underwent an exploratory laparotomy and was diagnosed with acute bilateral salpingitis. This case highlights the diagnostic dilemmas facing those caring for an adolescent girl with abdominal pain and presents an extremely rare etiology for abdominal pain in a nonsexually active adolescent.

Endosalpingiosis in conjunction with ovarian serous cystadenoma mimicking metastatic ovarian malignancy.

PATIENT: Female, 26. FINAL DIAGNOSIS: Endosalpingiosis. SYMPTOMS: Chronic pelvic pain. MEDICATION: -. CLINICAL PROCEDURE: Diagnostic laproscopy (conservative management). SPECIALTY: Obstetrics and Gynecology. OBJECTIVE: Challenging differential diagnosis. BACKGROUND: Interesting and unusual case of endosalpingiosis mimicking ovarian malignancy presentation. CASE REPORT: A 26-year-old G0P0 white female presented to our office with chronic pelvic pain. On vaginal examination, a nontender mass in left the adnexal region was palpable. Transvaginal ultrasound showed a left ovarian cyst. Laparoscopy was performed, which revealed diffuse bilateral ovarian excrescences with unusual multiple studdings throughout the peritoneum and abdominal cavity. Due to a suspicion of malignancy, a biopsy specimen was obtained for frozen sectioning. The specimen proved to be consistent with benign papillary serous cystadenofibroma. Gross appearance was still suspicious for malignancy and therefore left paraovarian cystectomy was performed. Additional specimens showed ovarian adenofibroma and endosalpingiosis. The patient's complaint of pelvic pain improved after laparoscopy. Due to diffuse presentation of endosalpingiosis in the peritoneum, serial CT scan of abdomen and pelvis at 6-month intervals was recommended. CONCLUSIONS: To our knowledge, this is an unusual case of a young, nulliparous female presenting with diffuse-presentation endosalpingiosis in the abdomen and peritoneum, which on gross examination was suspicious for malignancy. By following a conservative approach and performing serial CT scans, the patient will be clinically monitored.

Periappendicitis: our 13 year experience.

INTRODUCTION: Periappendicitis is defined as appendiceal serosal inflammation without mucosal involvement. It is a rare benign pathology, diagnosis is difficult and carries high morbidity. A detailed literature and large series are still lacking on periappendicitis. Aim of this study is to present our clinical experience with periappendicitis. METHODS: 36 of retrospectively reviewed 1232 acute appendicitis patients were found to have periappendicitis on histopathological examination. Histopathological finding of appendicitis with periappendicitis in emergency appendectomy, and cases of interval appendectomy were excluded. Descriptive statistics were used to summarize the data. RESULTS: The most common diagnosis was salpingitis (12), followed by pelvic inflammatory disease (9), typhoid enteritis (5), peritoneal tuberculosis (3), inflammatory bowel disease (3), and amoebiasis (1), while 3 cases remained undiagnosed. DISCUSSION: Periappendicitis is due to extra-appendicular pathologies resulting in serosal inflammation of the appendix without mucosal involvement. In the absence of any significant history, it is difficult to distinguish periappendicitis from the common entity of acute appendicitis only on the basis of clinical examination and laboratory parameters. CONCLUSION: Pre-operatively, it is difficult to diagnose periappendicitis, but it should be considered if the clinical signs and imaging findings are suggestive of any associated pathology in addition to the presence of typical picture of acute appendicitis and post-operatively if the patient develops any new clinical signs, as this can cause morbidity to a significant level.

Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient.

We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing.

Large bilateral tubercular pyosalpinx in a young woman with genitourinary malformation: a case report.

INTRODUCTION: Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent or presents with very few specific symptoms. In adolescents and young women, tuberculosis can also present with hypogastric recurrent symptoms and affectation of the general state, but because in our country genital tuberculosis is uncommon, its diagnosis is unlikely. CASE PRESENTATION: We describe the case of an 18-year-old Spanish woman who had been sexually active for 1 year, nulliparous, who presented with hypogastric discomfort and repeated urinary symptoms complicated with pelvic inflammatory disease after a hysterosalpingography. Genital tuberculosis was not suspected. The echographical findings and tumor markers mimicked those of ovarian tumors, and she was also a carrier of a genitourinary malformation (pelvic kidney and septate uterus). A laparotomy was performed and revealed large pelvic abscesses. On her right adnexum, the large pyosalpinx was free (floating pyosalpinx). Drainage, adhesiolysis and bilateral salpingectomy were performed, and cultures were taken. Histopathological study showed bilateral granulomatous abscessificated salpingitis with suspicion of genital tuberculosis, and cultures were positive for Mycobacterium tuberculosis. She followed a tuberculostatic treatment for 6 months. Eight years later, she presents with normal menstruations and is waiting for an in vitro fertilization cycle. CONCLUSIONS: No other reported case showing similar association of genital tuberculosis and genitourinary malformation was found. The associated genitourinary malformation in this case probably has no relation but it could contribute to diagnosis delay and/or to reactivate the pathology. The hysterosalpingographical findings and the observation of a floating pyosalpinx must alert the clinician to genital tuberculosis, but the diagnosis is suggested by the histopathological studies and confirmed by cultures. In this case study, the necessity of considering the risk of pelvic inflammatory disease reactivation after hysterosalpingography, of suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.