The Great Mimicker: Variable Presentations of Xanthogranulomatous Salpingo-Oophoritis in a Case Series of Seven Patients From a Rural Tertiary Care Center.

Xanthogranulomatous salpingo-oophoritis (XGSO) is an uncommon, non-neoplastic chronic destructive inflammatory condition. Its clinical and radiological features frequently masquerade as advanced ovarian malignancy or refractory pelvic inflammatory disease, posing a notable diagnostic challenge. Histopathological examination remains the gold standard for diagnosis. A retrospective clinicopathological evaluation of seven distinct cases of xanthogranulomatous adnexal inflammation was performed. Clinical symptoms, diagnostic imaging, intraoperative details, surgical approaches, and gross and microscopic evaluations were thoroughly analyzed. The age of the patients varied from 24 to 68 years. The predominant clinical manifestations included lower abdominal pain, fever, palpable mass, or abnormal uterine bleeding. In the majority of cases, imaging modalities primarily revealed complex solid-cystic ovarian masses, mimicking pelvic malignancy. Surgical management ranged from cystectomies to total abdominal hysterectomies with bilateral salpingo-oophorectomy. Histopathology confirmed the diagnosis in all cases, demonstrating replacement of the target adnexal parenchyma by sheets of lipid-laden foamy histiocytes intermixed with plasma cells, lymphocytes, polymorphonuclear leukocytes, occasionally scattered giant cells, and adjacent stromal fibrosis. XGSO remains a true mimic of pelvic malignancies. Histopathological analysis is essential for accurate identification and differentiation from neoplasm or other granulomatous conditions. Clinical awareness of the condition can prevent unnecessary radical surgical overdiagnosis.