Decidualized Endometrioma Masquerading as Ovarian Cancer in Pregnancy

Groszmann, Yvette; Howitt, Brooke E.; Bromley, Bryann; Feltmate, Colleen M.; Benacerraf, Beryl R.

doi:10.7863/ultra.33.11.1909

Cited by 13 publications

(6 citation statements)

References 13 publications

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“…4 Another series of 17 cases also having surgery for DEs resembling a malignancy was reported, all of which had a benign result. 5 In contrast, a series of 24 cases which were expectantly managed during pregnancy for the sonographically described DEs appearing to be possibly malignant revealed the resolution of this decidualization at the conclusion of each pregnancy, serving to be reassuring for this expectant type of management. 6 Further commentary of the benefit of expectant management of pregnancy-related DEs was recently reinforced.…”

Section: Discussionmentioning

confidence: 99%

Decidualized Endometrioma: Its Sonography and Optimal Clinical Management

Fernández

Levine

Sodini

et al. 2021

Journal of Diagnostic Medical Sonography

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Endometriosis is a condition which affects many reproductive age women. During pregnancy, an ovarian endometrioma may undergo decidualization, which may take on the sonographic appearance suggestive of malignancy. In this instance, a surgical approach for treatment may be deemed necessary. Three cases are presented with different outcomes, worthy of viewing the contrasting management. In case 1, a patient was diagnosed with a left ovarian cyst at her routine 20-week gestation sonogram. This sonographic examination was suggestive of an ovarian malignancy. The patient underwent laparoscopy with left salpingo-oophorectomy at 23 weeks gestational age, without complications. The pathologic diagnosis of the removed mass was a decidualized endometrioma. In case 2, a female patient presented with bilateral ovarian decidualized endometriomas that were demonstrated sonographically and had the appearance of malignancy. This patient was treated conservatively with serial follow-up sonograms during her pregnancy. At the 2-month post-partum follow-up sonogram demonstrated persistent bilateral endometriomas, without decidualization. However, in case 3, possible decidualization of an endometrioma was seen, and a follow-up sonogram revealed the presence of ovarian carcinoma. There is previously published support for watchful waiting when similar sonographic findings, in pregnancy, are seen.

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Section: Discussionmentioning

confidence: 99%

Decidualized Endometrioma: Its Sonography and Optimal Clinical Management

Fernández

Levine

Sodini

et al. 2021

Journal of Diagnostic Medical Sonography

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show abstract

“…DePriest and DeSimone reported that investigations with regard to blood flow on Doppler demonstrated that Doppler examination did not further facilitate diagnosis compared with gray-scale sonography alone, with a similar false-positive rate of 49% for the prediction of malignancy (6). Groszmann et al did not identify any morphological or vascular flow characteristics that were helpful in sonographically distinguishing benign decidualized endometrioma from malignancy (7).…”

Section: Discussionmentioning

confidence: 99%

Benign pelvic masses masquerading as adnexal cancer during pregnancy on ultrasound: A retrospective study of 5 years

Xie

Zhang

Wang

et al. 2015

Molecular and Clinical Oncology

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Abstract. This study was conducted to investigate the sonographic characteristics of benign adnexal masses misdiagnosed as malignancy, and determine whether sonographic findings may help distinguish these lesions from malignant tumors during pregnancy at a single center. We herein present our experience with pregnant women with benign adnexal masses misdiagnosed as malignancy by ultrasound and operated on during pregnancy or after delivery. A total of 4 cases of benign pelvic masses were misdiagnosed as adnexal cancer over a 5-year period, including an ovarian theca cell tumor with luteinization, an obsolete ectopic pregnancy of fallopian tube, an ovarian mature teratoma with abundant nervous tissue and a uterine myoma with degeneration. The masses were characterized by abundant blood flow and heterogeneous echo on ultrasound. In conclusion, adnexal masses identified during pregnancy exhibiting abundant blood flow and heterogeneous echo may not represent malignancy, even in the presence of increased carbohydrate antigen 125 levels. In certain cases, benign adnexal masses may be initially misdiagnosed as malignant during pregnancy.

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“…Under the action of progesterone, hypertrophy of the endometrial stromal cells leads to cyst enlargement and irregular and vascular solid components, mimicking malignancy on imaging, potentially leading to unnecessary surgical intervention. Decidualized ovarian endometrioma in pregnancy is a rare condition and we only identify 18 studies comprising a total of 61 cases of ovarian decidualized endometriomas during pregnancy after the literature review [3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The main characteristics of the published cases are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Decidualized ovarian endometrioma mimicking malignancy in pregnancy: a case report and literature review

Yin

Wang

et al. 2022

J Ovarian Res

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Background Ovarian endometrioma is a common gynecologic disease among reproductive-aged women. Pregnancy-related hormonal status may lead to changes of decidualization, which may resemble ovarian malignancies in sonographic appearance. Here we present a case of decidualized ovarian endometrioma clinically mimicking malignant transformation. Case presentation A 37-year-old pregnant woman presented to our hospital at 25 + 5 weeks of gestation with a persistent left adnexal mass that was first detected on routine ultrasound in the first trimester. Transvaginal and transabdominal ultrasound showed a cystic mass of size 8.4 × 5.8 cm in the left ovary with abundant blood flow signals in the papillary medium echo of the capsule wall and inner wall, raising concern for malignant ovarian tumor. After a multidisciplinary discussion, the patient underwent laparoscopic left salpingo-oophorectomy. The results of the frozen section revealed decidualized endometrioma and the final histopathology confirmed endometrioma with extensive decidualization. The patient’s postoperative recovery was uneventful and she was discharged on the 4th postoperative day. Conclusions Decidualized ovarian endometrioma is rare. Sonography and magnetic resonance imaging are helpful for differential diagnosis. Conservative management of expectant management and serial monitoring should be adopted if decidualized endometriosis is suspected.

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Decidualized Endometrioma Masquerading as Ovarian Cancer in Pregnancy

Cited by 13 publications

References 13 publications

Decidualized Endometrioma: Its Sonography and Optimal Clinical Management

Decidualized Endometrioma: Its Sonography and Optimal Clinical Management

Benign pelvic masses masquerading as adnexal cancer during pregnancy on ultrasound: A retrospective study of 5 years

Decidualized ovarian endometrioma mimicking malignancy in pregnancy: a case report and literature review

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