Unusually rapid growth of bilateral endometriomas and acute bilateral hydronephrosis

Abstract

Ultrasonography can detect ovarian endometriomas, but negative findings cannot exclude other localizations of endometriosis, especially in symptomatic patients. We describe a case of sudden development of large bilateral endometriomas after a series of negative ultrasound scans, causing bilateral hydronephrosis. Our patient is a 32-year-old nulligravida with long-lasting dysmenorrhea, urinary symptoms, and familiarity for endometriosis, who had voluntarily discontinued oral contraceptives. Various pelvic scans had not shown pathological findings. Five months following the last negative scan, she presented with pain and increase of abdominal girth. Ultrasonography and computed tomography showed large ovarian cysts (16 cm right - 10 cm left) and hydronephrosis bilaterally. She underwent conservative surgery followed by GnRH analogs. At a 6-months follow-up, she was symptom-free and ultrasonography showed no recurrence. Endometriosis has still an unknown mechanism of proliferation and its clinical behavior or progression is highly unpredictable. Severe uropathy is commonly related to direct ureteral involvement, but can also depend on an ab-extrinseco compression by large, rapidly growing endometriomas. Women at risk of endometriosis, who are not receiving empirical medical treatment, should be adequately and regularly assessed via pelvic ultrasonography and/or submitted to diagnostic laparoscopy in order to prevent serious consequences such as silent renal loss.

Visualization of ureters on standard gynecological transvaginal scan: a feasibility study

“…In women with pelvic endometriosis, the ureters may be directly affected by the disease or they could be compressed ovarian endometriomas or ovarian adhesions. Detection of ureteric involvement is of critical importance in conducting safe surgical treatment of severe pelvic endometriosis.…”

How Predictable Is the Operative Time of Laparoscopic Surgery for Ovarian Endometrioma?

“…Besides, the heterogeneity of endometriosis seems to reflect also on the severity of the disease, for which we are still probably lacking important knowledge and a reliable staging system. Similar lesions, such as ovarian endometriomas, have variable pathological and clinical behaviors in different women [ 16 ], thus leading to surgical difficulty of unpredictable level or, as we have previously documented, different rates of recurrence [ 11 ].…”

Is a Positive Family History of Endometriosis a Risk Factor for Endometrioma Recurrence After Laparoscopic Surgery?

“…24 Great clinical variability exists between patients, and a certain grade of unpredictability is linked to endometriosis. 25 In some women, adenomyosis, a still poorly understood and possibly underdiagnosed condition, might complicate the picture and be responsible for the disappointing persistence of symptoms after appropriate or even radical, uterus-sparing surgery. [26][27][28] In this study, we have tried to focus on several possible factors but have failed to demonstrate a significant association of endometrioma recurrence with most of the studied variables.…”