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Thanks to Dr. Raul Gonzalez, University of Rochester Medical Center, New York (USA), for contributing this case.
This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.
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Case of the Week #356
A 48 year old woman with bilateral ovarian endometriosis had a bilateral salpingo-oophorectomy. Sections of the fallopian tubes are shown in the images.
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% confirming its close association with endometriosis. An iron stain was positive in pseudoxanthoma cells lacking hemosiderin in 78% of cases (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
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