Xanthogranulomatous oophoritis: malignant appearance, benign pathology

Xanthogranulomatous oophoritis (XO) is a rare inflammatory condition of the female genital tract that closely mimics malignancy due to its non-specific clinical presentation and mass-like appearance on imaging. It is histologically characterised by lipid-laden macrophages, chronic inflammatory cells and necrosis. We report the case of a woman in the late 60s referred to the gynaecologic oncology clinic for evaluation of a newly identified complex ovarian mass on CT. She underwent surgical intervention with histopathological examination confirming the diagnosis of XO with extension into the uterine wall and peri-appendicitis. Postoperative recovery was uneventful, and intraoperative cultures grew Bacteroides fragilis , suggesting a potential infectious aetiology. XO remains a diagnostic challenge due to its resemblance to ovarian malignancy. This case underscores the importance of considering XO in patients presenting with adnexal masses, particularly those with a history of chronic pelvic inflammation or infection. Awareness of this rare entity can help prevent unnecessary radical surgeries, improve patient outcomes, and guide future research into its pathogenesis and management strategies.