All cases are archived on our website. To view them sorted by number, diagnosis or category, visit our Home Page and click on the Case of the Week button on the left hand side. To subscribe or unsubscribe to the Case of the Week or our other email lists, click here.
Thanks to Dr. Raul Gonzalez, University of Rochester Medical Center, New York (USA), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
(1) We have now listed several new webinars from American Society of Clinical Pathology on our Webinars page. Also, don't forget to check out Ventana's new product announcement on our New Products and Services page!
(3) You don't want to miss any of our blog posts, so subscribe and get our posts emailed to you! Simply go to our Blog Homepage, and on the right hand side put your email address in the field under "Follow by Email". You will receive an email asking you to confirm. It's that easy! You will only get one email per day (at most), and only on the days which we post a new entry.
(4) Our Feature page for June is Diagnostic Testing / Reagents, and highlights our advertisers Advanced Cell Diagnostics, Inc. (ACD) and Ventana Medical. It also contains an original short article, "Diagnostic Agents in Personalized Medicine: The Era of Pharmacogenomics", by Jaleh Mansouri, M.D.
(5) Visit our Updates page to see recent updates to the textbook, including 7 new topic reviews in the past week.
Case of the Week #356
A 48 year old woman with bilateral ovarian endometriosis had a bilateral salpingo-oophorectomy.
What is your diagnosis?
Discussion: Pseudoxanthogranulomatous salpingitis is a rare disorder characterized by the accumulation of histiocytes containing iron, lipofuscin and hemosiderin in the lamina propria of the fallopian tube, with accompanying chronic inflammatory cells (Int J Gynecol Pathol 2010;29:248). A recent study of 49 cases indicated a history of endometriosis in 20%, but histologic evidence of endometriosis was identified in the fallopian tubes in 35% and at all sites in 65%. An iron stain was positive in pseudoxanthoma cells lacking hemosiderin in 78%, confirming its close association with endometriosis (Int J Gynecol Pathol 2015;34:275, Mod Pathol 1993;6:53), often ovarian, as well as IUD use and radiotherapy. It may be due to actively bleeding ovarian endometriosis, which leaks blood into the lumen of the fallopian tube.
The differential diagnosis includes xanthogranulomatous salpingitis, characterized by excessive foamy macrophages with lymphocytes, plasma cells and occasional neutrophils (Clin Exp Obstet Gynecol 2008;35:291). Symptoms include fever, lower abdominal or suprapubic pain, menorrhagia, vaginal bleeding, adnexal tenderness or a pelvic mass, and it may involve the adjacent ovary. It is often an unusual manifestation of chronic pelvic inflammatory disease (Int J Gynecol Pathol 2002;21:56).
Tubal excision is adequate treatment of pseudoxanthomatous salpingitis, although the underlying endometriosis may cause additional symptoms.
Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025