Xanthogranulomatous oophoritis

Editor-in-Chief: Debra L. Zynger, M.D.
Jack Reid, M.D.
Jian-Hua Qiao, M.D.

Last author update: 25 October 2019
Last staff update: 23 August 2022

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PubMed Search: Xanthogranulomatous oophoritis

Jack Reid, M.D.
Jian-Hua Qiao, M.D.
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Cite this page: Reid J, Qiao JH. Xanthogranulomatous oophoritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorxanthogranoophoritis.html. Accessed February 23rd, 2024.
Definition / general
  • Xanthogranulomatous oophoritis is an uncommon, nonneoplastic, chronic process (Iran J Pathol 2018;13:372)
  • Destruction by massive cellular infiltration of foamy histiocytes admixed with multinucleated giant cells, plasma cells, fibroblasts, neutrophils and foci of necrosis (Iran J Pathol 2018;13:372)
Essential features
  • Xanthogranulomatous oophoritis is a rare form of chronic oophoritis (J Indian Med Assoc 2012;110:653)
  • Affects fallopian tubes or ovaries focally or entirely, forming a mass-like lesion in the pelvic cavity that invades the surrounding tissues (J Cancer 2012;3:100)
  • Xanthogranulomatous oophoritis
  • Xanthogranulomatous inflammation of the ovary
  • Xanthogranulomatous inflammation of the female genital tract
  • Ovarian fibroxanthoma
ICD coding
  • ICD-10: N70.92 - oophoritis, unspecified
  • Most frequent in females of reproductive age (range: 23 - 72 years)
  • Average age of patients with affected ovaries is 31 years (AJR Am J Roentgenol 2002;178:749)
  • Only 13 related cases of xanthogranulomatous inflammation involving fallopian tube or ovary have been described through 2012 (J Cancer 2012;3:100)
  • Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity (J Ayub Med Coll Abbottabad 2017;29:162)
  • Exact pathophysiology is unknown
  • Associated with infection, ineffective antibiotic therapy
  • Ineffective clearance of bacteria by phagocytes, endometriosis, intrauterine contraceptive device, pelvic inflammatory disease and drugs (antibiotics) is suggested (Iran J Pathol 2018;13:372)
  • Development can be of multiple predisposing factors, for example, pelvic inflammatory diseases, intrauterine device use, uterine leiomyoma, endometriosis and inappropriate antibiotic intake (BMJ Case Rep 2015 Jun 25;2015)
Clinical features
  • Longstanding history of pelvic inflammatory disease
  • Symptoms such as anorexia, fever, suprapubic pain, menorrhagia or vaginal bleeding, adnexal tenderness and a pelvic mass are the usual chief complaints (Iran J Pathol 2018;13:372)
Radiology description
  • Ultrasound of the abdomen reveals a thick walled, cystic hyperechoic ovarian mass (Iran J Pathol 2018;13:372)
  • Pelvic CT scan shows a peripherally enhancing ovarian cystic lesion, which represents either an inflammatory process or ovarian neoplasm (Iran J Pathol 2018;13:372)
  • Presence of nonenhancing intramural nodules in the thickened wall of an ovarian cystic mass may be a unique MRI indicator of xanthogranulomatous oophoritis (AJR Am J Roentgenol 2002;178:749)
Radiology images

Images hosted on other servers:

Pelvic sonography
shows a mixed
echogenicity mass

T2 MRI shows multiseptated cystic mass

Axial T2 weighted turbo spin echo MRI (TR / TE, 3900 / 99)

Axial T1 weighted spin echo MRI (800 / 12)

Prognostic factors
  • Since xanthogranulomatous oophoritis is usually associated with pelvic inflammatory disease, endometriosis, intrauterine death, etc., these patients should be followed up closely (Indian J Pathol Microbiol 2010;53:197)
Case reports
Gross description
  • Ovarian lesion usually has a solid mass with rugged outer surface
  • Serial sectioning mostly reveals tan, grayish white and necrotic cut surfaces (J Cancer 2012;3:100)
Gross images

Contributed by Jian-Hua Qiao, M.D.

Yellow nodules

Microscopic (histologic) description
  • Usually shows characteristic dense fibrosis with infiltration of the ovarian stroma by sheets and nodules of foamy macrophages, many histiocytes, lymphocytes and neutrophils (Iran J Pathol 2018;13:372)
Microscopic (histologic) images

Contributed by Jian-Hua Qiao, M.D.

Foamy histiocytes in cystic wall

Foamy histiocytes mixed with inflammatory cells

Foamy histiocytes

Positive stains
Negative stains
Sample pathology report
  • Left ovary and fallopian tube, left salpingo-oophorectomy:
    • Cystic ovary with endometriosis
    • Extensive xanthogranulomatous oophoritis
    • Fallopian tube with no significant pathologic change
Differential diagnosis
  • Ovarian carcinoma:
    • May be difficult to differentiate with imaging
    • Gross and microscopic pathologic findings will easily differentiate malignant tumors from inflammatory lesions
  • Endometrioma:
    • Usually filled with chocolate colored fluid
    • Histologic sections of cystic wall show hemosiderin laden macrophages without abundant foamy histiocytes
  • Tubo-ovarian mass:
    • Benign tumors can occur in the tubo-ovarian area, i.e. leiomyoma
    • Gross and histologic examinations reveal smooth muscle neoplasm rather than inflammatory process / lesion
Board review style question #1
This gross photo of an ovary is most consistent with:

  1. Endometriotic cyst / endometrioma
  2. Leiomyoma
  3. Ovarian malignancy / carcinoma
  4. Ovarian simple cyst
  5. Xanthogranulomatous oophoritis
Board review style answer #1
E. Xanthogranulomatous oophoritis (the gross photo shows variably sized yellow nodules, which are consistent with changes of xanthogranulomatous nodules of ovary).

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Reference: Xanthogranulomatous oophoritis
Board review style question #2
This microscopic photo of an ovary includes changes of:

  1. Endometriosis and xanthogranulomatous oophoritis
  2. Hemorrhagic corpus luteum cyst
  3. Ovarian malignancy / carcinoma
  4. Ovarian simple cyst
Board review style answer #2
A. Endometriosis and xanthogranulomatous oophoritis. The microscopic photo shows endometriosis with increased foamy histiocytes in stroma and adjacent soft tissue, consistent with xanthomatous change.

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Reference: Xanthogranulomatous oophoritis
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