The abnormal localized deposition of lipofuscin-laden macrophages in the lamina propria of the fallopian tube (pseudoxanthomatous salpingiosis) is reported in two women. In both cases there was evidence of longstanding endometriosis; necrotic pseudoxanthomatous nodules of the ovary were present. Histochemical and ultrastructural analysis of the pigment confirmed that it is lipofuscin (ceroid). It is proposed that pseudoxanthomatous salpingiosis develops after an episode of acute salpingitis during which actively bleeding ovarian endometriosis leaks blood into the lumen of the fallopian tube.