Design: We discuss an individual patient presentation and management.

Setting: Tertiary care, academic hospital.

Patients or Participants: A healthy female patient in her 40s presenting in the emergency department with pelvic pain for 2 days.

Interventions: During surgery, surgeons identified a right adnexal mass along with free fluid and multiple 1-2 mm implants diffusely scattered throughout the pelvis. Consequently, malignancy was considered in the differential diagnosis, leading to a decision to perform a right salpingo-oophorectomy, along with several biopsies for further analysis.

Measurements and Main Results: The laparoscopic intervention proceeded without complications, and the patient's recovery was uneventful. The histopathology report confirmed the presence of a right mature teratoma. Unexpectedly, all additional biopsies revealed diffuse xanthogranulomatous inflammation. One month post-surgery, the patient had resumed all normal activities and reported no further symptoms.

Conclusion: Xanthogranulomatous inflammation is a rare entity to encounter in gynecology. It is characterized by foamy histiocytes and other inflammatory cells. As Inflammation progresses, normal tissue is destroyed and replaced, and may mimic malignancy. Diagnosis is made by histopathology and treatment is mainly surgical.