Imaging in gynecological disease (10): clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy

Mascilini, F.; Moruzzi, C; Giansiracusa, C.; Guastafierro, F.; Savelli, L.; Meis, Lucia De; Epstein, Elisabeth; Timor‐Tritsch, I. E.; Mailáth-Pokorny, Mariella; Ercoli, Alfredo; Exacoustòs, C.; Benacerraf, B.; Valentin, Lil; Testa, Antonia Carla

doi:10.1002/uog.13323

Cited by 76 publications

(45 citation statements)

References 25 publications

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“…Ultrasound examiners should always take into account the phenomenon of decidualisation, which is a major contributory factor to incorrect diagnosis in pregnant women [21]. Most decidualised endometriomas (82%) were described as manifesting vascularised rounded papillary projections with a smooth contour in an ovarian cyst with one or more cyst locules and ground glass, or low level echogenicity of the cyst fluid [22]. …”

Section: Endometriomas and Malignancymentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

212

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Section: Endometriomas and Malignancymentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

212

143

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“…In the present case, both ovaries were normal and a retro‐uterine fast‐growing solid mass was described. Although ultrasound pattern recognition of decidualized endometrioma was recently described by Mascilini et al , there are no cases in the literature of decidualized atypical endometriotic localization, as in the present case …”

Section: Discussionmentioning

confidence: 57%

Diagnosis and laparoscopic management of a rare endometriosis‐related peritoneal mass with rapid growth in early pregnancy

Donato

Facchini

Leggieri

et al. 2015

J of Obstet and Gynaecol

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Herein is described the diagnosis, clinical management and laparoscopic removal of a rapid growing retro-uterine mass in a pregnant woman. After laparoscopic removal of the pelvic mass, diagnosis of peritoneal endometriotic cyst was made on histology. The patient was asymptomatic and no history of endometriosis was reported. The laparoscopic management of the peritoneal mass was safe and effective and to our knowledge this is the first case report describing a decidualized endometriotic lesion in the absence of a pre-pregnancy endometriosis diagnosis.

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“…In our study, 8 of 21 masses had at least 1 septation, and 1 mass had developed a septation on follow‐up examination, suggesting that this characteristic is not a useful distinguishing feature in our population. Mascilini et al 9 evaluated 18 cases of decidualized endometriomas gathered from 7 centers (including patient 3 in this study). They found that 15 of the 18 decidualized endometriomas contained rounded papillary projections with a smooth contour and suggested that these rounded papillations were different from those associated with malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…These inclusion criteria generated a study population of 17 patients with 22 adnexal masses. One case (patient 3) was also included in a previous multicenter study by Mascilini et al 9 but was not deleted from our cohort due to the consecutive and inclusive design of our own study.…”

Section: Methodsmentioning

confidence: 99%