Xanthogranulomatous inflammation is a rare but serious form of chronic granulomatous disorder that causes destruction to the affected organ such as kidney and bladder. Pathologically, it is characterised by lipid-laden foamy macrophages and cellular infiltrates such as neutrophils, lymphocytes and plasma cells. Xanthogranulomatous oophoritis (XO) involves the ovary and although it has previously been reported, this is the first case that coexists in pregnancy.

A 30-year-old female, Para 1 was referred to our centre for further management of suspected ovarian malignancy. She presented with one-year history of gradual abdominal distension associated with non-cyclical right-sided abdominal pain and significant weight loss. She has regular menses with no urinary or bowel symptoms. Prior to coming to us, patient underwent ozone therapy, which she claimed improved her symptoms temporarily. Abdominal examination revealed a firm pelvic mass of 20 weeks size with restricted mobility. Ultrasound and CT scan showed a right-sided multiloculated cystic ovarian mass measuring 10×8 cm with no ascites, with normal tumour markers. Patient was advised for surgery; however, she conceived spontaneously and wished to keep her pregnancy. MRI revealed a complex right ovarian cyst with suspicion of malignancy. Throughout the pregnancy, she remained well but had moderate iron deficiency that required treatment with parental iron. The mass continued to increase in size with large vascularity seen on Colour Doppler. She had a planned elective repeat lower segment Caesarean section, right salpingo-oophorectomy and appendicectomy at 37 weeks of gestation. Intraoperatively, uterus was 36 weeks size being pushed to the left by the ovarian mass. There was no ascites however peritoneal washing was sent for cytology. There was a right-sided ovarian mass measuring 12×12 cm mimicking tubo-ovarian abscess, which was adhered to the recto-sigmoid colon and fixed to the Pouch of Douglas. Adhesiolysis was done and the cyst ruptured, extruding pus discharge. Incidental finding of hepatomegaly and subserosal fibroid measuring 4×4 cm which myomectomy was done. Histopathological examination revealed a diagnosis of right Xanthogranulomatous oophoritis and leiomyoma with negative cytology.

Xanthogranulomatous oophoritis is a rare disorder which to date only 20 cases reported in literature and none reported to occur during pregnancy. Zhang et al reported in 2012 that clinical manifestations, imaging and macroscopic observation of XO are subject to be confused with ovarian malignancy. In pregnancy the window for surgical treatment is narrow. Despite knowing the risk of malignancy, patient wished to continue her pregnancy and refused any surgical intervention. Therefore, she was treated conservatively and allowed to carry the pregnancy till term.