Huge polypoid endometriosis: report of a case and review of the literature

Abstract

'Polypoid endometriosis' is a rare variant of endometriosis. We describe a case of an extremely large polypoid endometriosis mimicking a malignant tumor. A 37-year-old nulliparous woman was referred due to the rapid growth of an endometriotic cyst of the ovary and a high serum CA125 level. MRI revealed solid components in the pelvic mass. These preoperative clinical data were compatible with an ovarian carcinoma. A frozen section of the tumor biopsy showed as if an adenosarcoma, but finally the diagnosis of polypoid endometriosis with decidual change was made on permanent section. Polypoid endometriosis is a part of the differential diagnosis for malignant tumors in women with endometriosis, and we should consider carefully decision making for treatment.

Ultrasound features of polypoid endometriosis: a case report and a short review of Literature

“…20 In some cases of PEM, external protrusions from the mass can be visualized infiltrating the vagina or the uterus, with blood flow through these connections 5 : at surgery this can correspond to lesions apparently arising from uterine serosa. 5,6 The same feature was reported in our patient, and misinterpreted as a carcinomatosis implant on the uterine wall at TVUS. Moreover, the sonographic finding of a hypoechoic area with an infiltrative appearance, as in the present case, might sometimes imply a complex differential diagnosis with deep infiltrating endometriosis (DIE), which is sometimes associated with ovarian endometriomas.…”

“…2 At imaging studies, this characteristics correspond to irregular and heterogeneous infiltrative masses which can show central hemorrhage areas and solid components, with a reduced or negative sliding between the lesion and organs such as the uterus or the rectum. [4][5][6][7] At MRI scan, PEM can present as heterogeneous masses with high signal intensity in T2-weighted images, accompanied by a peripheral T2-hypointense rim corresponding to fibrous tissue [7][8][9] ; other features can include a lobulated nodular profile; central irregular T2-hyperintense areas with "shadow sign," corresponding to hemorrhage foci; mild enhancement resembling that of uterine eutopic endometrium; and lack of diffusion restriction, implying absence of high cellularity. [5][6][7][8][9] Ascites, peritoneal implants and lymphadenopathy are usually absent.…”

“…[4][5][6][7] At MRI scan, PEM can present as heterogeneous masses with high signal intensity in T2-weighted images, accompanied by a peripheral T2-hypointense rim corresponding to fibrous tissue [7][8][9] ; other features can include a lobulated nodular profile; central irregular T2-hyperintense areas with "shadow sign," corresponding to hemorrhage foci; mild enhancement resembling that of uterine eutopic endometrium; and lack of diffusion restriction, implying absence of high cellularity. [5][6][7][8][9] Ascites, peritoneal implants and lymphadenopathy are usually absent. [7][8][9] At TVUS examination, PEM has been described as voluminous heterogeneous masses, with irregular echogenicity and sometimes the presence of cystic areas 4,5 ; its imaging features can imply a difficult differential diagnosis with ovarian malignancy, although sometimes normally appearing uterus and adnexa can be observed.…”

Polypoid Endometriosis of the Rectum and Vagina in an Adolescent

“…Polypoid endometriosis (PEM) is a rare and distinctive type of endometriosis (EM) mimicking malignant tumor clinically and intraoperatively. 1 Analysis showed more than half of patients were older than the age of 50 years 2 and only a few patients are young women. PEM of the rectum and vagina with the infiltrative type was rarely reported, especially in adolescents and young adults.…”

Fertility preservation of polypoid endometriosis: Case series and literature review

“…There are reports of cases in which lesions decreased during GnRHa treatment but increased after treatment. 17,22 PE was reported to develop after hormone replacement therapy in peri-and postmenopausal status, and after tamoxifen administration for breast cancer. 2 Of the 63 PE cases reviewed in the literature, GnRHa was administered in four cases, and three of them showed a decrease in tumor size.…”