Background: Xanthogranulomatous salpingo-oophoritis is an infrequent and challenging diagnosis of the female genital tract. It involves the destruction of the fallopian tube and ovarian tissue by infiltrating inflammatory cells comprising lipid laden macrophages, lymphocytes, plasma cells, and multinucleated giant cells. While more commonly found in gall bladder and kidney, its occurence in female genital tract is rare. This is a case of Xanthogranulomatous salphingo-oophoritis in a 48 year woman who presented with chronic lower abdomen pain and frequent heavy menses for two months. On per abdomen examination a non tender 24 weeks size mass was felt and on vaginal examination the same mass was appreciated, seperate from the uterus. PAP was reported NILM. Ultrasound revealed uterine adenomyoma with bilateral endometrioma of ovaries and associated left hydrosalphinx. Patient underwent hysterectomy with bilateral salphingo-oopherectomy. Histopathological examination revealed uterine adenomyosis, chronic cervicitis with xanthogranulomatous salpingo-oophoritis. The patient recovered well and doing good on follow-up.

Conclusion: Xanthogranulomatous salpingo-oophoritis, though rare is a significant entity because clinically it can mimic chronic pelvic inflammatory disease or endometrioma and even in some cases malignancy. Even clinical examination and imaging might not help much. Therefore, knowledge and awareness about the condition with the help of histopathology can clinch the diagnosis and also prevent radical cancer surgery