We report a case of a 24-year-old woman who presented with abdominal pain, a tense abdomen, and rebound tenderness. A vague, ill-defined mass was palpated, and an ultrasound examination revealed a cystic lesion in the left adnexal region. At laparotomy, a slightly dilated fallopian tube was seen and excised. Light microscopy showed intact fallopian tube mucosa, with a diffuse infiltrate of foam cells in the lamina propria. There were no associated inflammatory cells. The foam cells were positive for CD68 and negative for AE1/AE3. Discontinuous areas of the epithelium also showed epithelial cells with "foamy cytoplasm." These cells were negative for CD68 but positive for AE1/AE3. To our knowledge, this represents the first case of a fallopian tube xanthelasma that shows a resemblance to lesions encountered in the stomach. Fallopian tube xanthelasma must be distinguished from xanthogranulomatous salpingitis, which is associated with an inflammatory cell infiltrate, often including giant cells. However, this lesion may share pathogenetic similarities with xanthogranulomatous salpingitis, since both processes are mediated by inflammation.