A benign illusion: elevated CA 19-9 and bilateral xanthogranulomatous salpingitis hiding behind pelvic endometriosis

Rahul Manchanda; Yash Bahuguna; Pragya Verma

doi:10.18203/2320-1770.ijrcog20264028

Authors

Rahul Manchanda Department of Division of Gynae Endoscopy, Pushpawati Sighania Research Institute, New Delhi, India
Yash Bahuguna Department of Division of Gynae Endoscopy, Pushpawati Sighania Research Institute, New Delhi, India
Pragya Verma Department of Laboratory Medicine, Histopathology and Cytopathology, Pushpawati Sighania Research Institute, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20264028

Keywords:

Xanthogranulomatous salpingitis, Pelvic endometriosis, Asymptomatic adnexal mass, Tubo-ovarian mass, Intraoperative frozen section

Abstract

Xanthogranulomatous salpingitis (XGS) is a rare, benign, chronic inflammatory tubal condition that frequently mimics advanced malignancy, and its concurrent presentation with endometriosis is exceptionally rare. We present the case of an asymptomatic 44-year-old female who was found to have a complex tubo-ovarian mass and an elevated CA 19-9 during a routine solid organ donor evaluation. Suspecting malignancy, diagnostic laparoscopy was performed. Crucially, intraoperative frozen section analysis revealed benign pathology, prompting a fertility-sparing surgical approach involving left mass excision, right salpingectomy, and endometriosis resection. Final histopathology unexpectedly confirmed bilateral XGS with concurrent pelvic endometriosis. This case highlights that XGS can develop entirely silently alongside endometriosis, likely driven by chronic hemorrhage rather than bacterial infection. Intraoperative pathological evaluation is imperative to prevent the radical oncological overtreatment of complex, adherent adnexal masses.

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