Xanthogranulomatous Endometritis Mimicking Endometrial Carcinoma: A Case Report and Literature Review

Abstract

Introduction: Xanthogranulomatous endometritis (XGE) is a rare chronic inflammatory condition of the endometrium, belonging to the group of xanthogranulomatous inflammations more commonly reported in the kidney and gallbladder. Its clinical and radiological presentation can mimic endometrial carcinoma, making preoperative diagnosis challenging. Case Presentation: We report the case of a 40-year-old woman with an 11-year history of infertility, presenting with intermittent metrorrhagia. Transvaginal ultrasound revealed a well-defined, heterogeneous, solid intrauterine mass measuring 110 × 80 × 62 mm, initially suggestive of a myoma or uterine sarcoma. Pelvic MRI confirmed an endometrial lesion of 110 × 80 × 40 mm with superficial myometrial invasion and a suspicious obturator lymph node classified, as FIGO IA. Hysteroscopy showed a hypertrophic, mamillated, highly vascularized endometrium. Endometrial biopsy confirmed xanthogranulomatous endometritis without evidence of malignancy. Infectious and immunological workup was unremarkable. The patient was treated with corticosteroids and monitored clinically and radiologically. After six months, PET-CT and follow-up hysteroscopy showed complete resolution of abnormalities. Conclusion: Xanthogranulomatous endometritis is a rare condition that can mimic endometrial cancer, requiring histopathological confirmation for accurate diagnosis. Conservative management with corticosteroids can be effective and may preserve reproductive function. Early recognition of this entity helps avoid unnecessary surgical interventions and guides appropriate treatment.