# Diagnostic Challenge of Xanthogranulomatous Salpingo‐Oophoritis in an 8‐Year‐Old Girl in a Low Resource‐Setting: A Rare Case Report

## TL;DR

An 8-year-old girl in Tanzania was misdiagnosed with cancer but later found to have a rare inflammatory ovarian condition.

## Contribution

This is the first reported case of xanthogranulomatous salpingo-oophoritis in Tanzania and highlights diagnostic challenges in low-resource settings.

## Key findings

- Xanthogranulomatous salpingo-oophoritis was confirmed histopathologically, excluding malignancy.
- Initial radiological findings suggested a retroperitoneal tumor with lung metastases, leading to a neuroblastoma diagnosis.
- Chemotherapy reduced tumor size, but definitive diagnosis required surgical intervention.

## Abstract

Xanthogranulomatous oophoritis is an extremely rare, chronic inflammatory condition of the ovary characterized by the replacement of normal ovarian tissue with lipid‐laden macrophages, plasma cells, and lymphocytes. When the genital tract is involved, this most commonly affects the endometrium, whereas ovarian and fallopian tube involvement is rare. It is often misdiagnosed due to its nonspecific clinical and radiological features, which can mimic neoplastic or infectious pathologies. This case report highlights a rare presentation in a pediatric patient and emphasizes the diagnostic challenges encountered, especially in low‐resource settings. To the best of our knowledge, this is the first reported case of its kind in Tanzania. We report a rare case of an 8‐year‐old girl who presented to our specialty hospital in Northern Tanzania with a history of progressive abdominal distension for 8 months. An abdominal CT scan with contrast revealed a large, heterogeneous, enhancing retroperitoneal mass with central necrosis, measuring 13 × 13 × 10 cm. The mass displaced the intestines superolaterally, compressed the urinary bladder inferiorly, and displaced the ureters laterally, resulting in bilateral hydroureteronephrosis. It abutted the bilateral iliac arteries and compressed the sigmoid colon. Multiple enlarged para‐aortic, periportal, and mesorectal lymph nodes were visualized, the largest measuring 2 × 2 cm. There was minimal free intraperitoneal fluid, and a CT scan of the chest with contrast revealed two micronodules in the anterior segment of the right upper lobe of the lung. Radiological findings were suggestive of a retroperitoneal tumor with pulmonary metastases. Based on clinical and radiological findings, a working diagnosis of Neuroblastoma was made. The patient was initiated on a standard Neuroblastoma chemotherapy protocol and received three cycles, which resulted in a significant reduction in tumor size. Subsequently, she underwent an exploratory laparotomy, during which a left salpingo‐oophorectomy was performed. Postoperative recovery was uneventful and the patient was discharged in stable condition. The final histopathological report showed xanthogranulomatous salpingo‐oophoritis, thus excluding the initial diagnosis of malignancy.