Polypoid endometriosis - A rare entity of endometriosis mimicking ovarian cancer

A Rare Presentation of Polypoid Endometriosis of the Douglas Pouch: Case Report

A case is reported of a 46-year-old woman referred to a magnetic resonance imaging (MRI) for menometrorrhagia. MRI revealed a mass lesion lateral to the uterus fundus, suspicious of an ovarian granulosa cell tumor. Extensive surgery was performed. Histological examination revealed a polypoid endometriosis lesion arising from the Douglas pouch. Teaching point: Polypoid endometriosis is a rare benign entity with a challenging differential diagnosis from malignancy. Specific MRI features can contribute to the diagnosis and thus avoid excessive surgical resection.

Rapidly growing extensive polypoid endometriosis after gonadotropin-releasing hormone agonist discontinuation: A case report

BACKGROUND

Polypoid endometriosis (PEM) is a rare and unique type of endometriosis. To date, no article has provided a systematic report of this disease. The current article provides a complete report on rare PEM based on ultrasound, magnetic resonance imaging, intraoperative findings and postoperative pathology data.

CASE SUMMARY

A 38-year-old female patient was admitted to our hospital after complaining of "vague pain in the right lower quadrant with an aggravated menstrual period for 8 mo". The patient underwent laparoscopic exploratory surgery on January 7, 2022. The postoperative pathology revealed extensive PEM.

CONCLUSION

PEM is a type of endometriosis that is a benign disease but has biological properties similar to malignant tumours.

MR findings of polypoid endometriosis of female genital organs: report of three cases

Polypoid endometriosis is a benign, rare variant of endometriosis that forms polypoid nodules mimicking malignant tumors. For three cases of polypoid endometriosis of female genital organs, this report presents characteristic MR imaging features reflecting the histopathological findings. The solid and microcystic pattern or the multilocular pattern both reflecting dilated endometrial glands, and characteristic morphology of the nodules, multilobulated or polypoid-shaped, were helpful diagnostic clues present in these three cases. Earlier reported MR findings were also recognized, including signal intensity similar to that of the endometrium on T2-weighted image and contrast enhanced T1-weighted image, hypointense rim on T2-weighted image, lack of diffusion restriction, and hyperintense foci on T1-weighted image. Two cases were diagnosed preoperatively based on MR imaging findings as polypoid endometriosis. Fertility-preserving treatment was administered for one patient. Preoperative inference of polypoid endometriosis from MR imaging can avoid overtreatment and lead to fertility preservation.

A case of polypoid endometriosis mimicking advanced ovarian carcinoma with rapid growth, invasion, and dissemination

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present.Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification.

Fertility preservation of polypoid endometriosis: Case series and literature review

Polypoid endometriosis (PE) is a rare distinctive variant of endometriosis with morphological features resembling malignant tumors. Although a surgical procedure is usually performed for the treatment and diagnosis of PE, fertility preservation is usually desired in cases of reproductive age. However, there have been no reports of fertility-preserving treatments resulting in live births. In this study, we report three cases of PE that were diagnosed preoperatively or intraoperatively, leading to fertility preservation. Intraoperative pathological diagnosis, hysteroscopy, and hormone therapy before treatment were useful for preoperative diagnosis in the three cases. Two of the three patients got pregnant and the pregnancy progressed to a live birth. We also performed a literature review to identify the clinical characteristics indicative of the preoperative diagnosis of PE.

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

Introduction:

Polypoid endometriosis is a rare variant of endometriosis characterized by histological features resembling an endometrial polyp. Lesions frequently affect the ovaries presenting as adnexal masses which may mimic malignancy, with an extremely complex differential diagnosis due to the poor evidence reported in Literature.

Case description:

In this report, we describe the case of a 43 years old woman referred to pelvic transvaginal ultrasound examination for recurrent abdominal pain, in whom sonography revealed a pelvic mass with features highly suspicious for ovarian carcinoma. Surgical removal allowed histopathological diagnosis of polypoid endometriosis, with no signs of malignancy. At ultrasound examination, the lesion appeared as a multilocular-solid mass, with low-level echogenicity of cystic content, multiple papillary projections, and solid areas with high vascularization and apparent infiltration of the uterus. At retrospective review of the sonographic images after pathological examination, some features mirroring the histological architecture of polypoid endometriosis could be identified in the solid components of the mass: these included the hyperechoic appearance, the rounded outline of the intracystic projections, and the vascularization pattern with a single central vessel with branching.

Conclusions:

To date, this is the first work providing a detailed ultrasonographic description of polypoid endometriosis using shared terms and definitions and relating these findings with available evidence about radiologic and histopathologic features. The report shows how this condition could strongly mimick ovarian malignancy, though several sonographic features can be identified reflecting the histopathological patterns of those lesions.

Organization of the Cytoskeleton in Ectopic Foci of the Endometrium with Rare Localization

(1) Background: Endometriosis is a common pathology of the female reproductive system, often accompanied by pain and decreased fertility. However, its pathogenesis has not been sufficiently studied regarding the role of the cytoskeleton. In this study, we describe two clinical cases involving rare localization of extragenital endometriosis (umbilicus) and compare them with genital endometriosis of different localization (ovaries and uterus), as well as eutopic endometrium obtained with separate diagnostic curettage without confirmed pathology. (2) Methods: The relative content of actin and tubulin cytoskeleton proteins was determined by Western blotting, and the expression of genes encoding these proteins was determined by RT-PCR in the obtained intraoperative biopsies. The content of 5hmC was estimated by dot blot experiments, and the methylase/demethylase and acetylase/deacetylase contents were determined. (3) Results: The obtained results indicate that the content of the actin-binding protein alpha-actinin1 significantly increased (p < 0.05) in the groups with endometriosis, and this increase was most pronounced in patients with umbilical endometriosis. In addition, both the mRNA content of the ACTN1 gene and 5hmC content increased. It can be assumed that the increase in 5hmC is associated with a decrease in the TET3 demethylase content. Moreover, in the groups with extragenital endometriosis, alpha- and beta-tubulin content was decreased (p < 0.05) compared to the control levels. (4) Conclusions: In analyzing the results, further distance of ectopic endometrial foci from the eutopic localization may be associated with an increase in the content of alpha-actinin1, probably due to an increase in the expression of its gene and an increase in migration potential. In this case, a favorable prognosis can be explained by a decrease in tubulin content and, consequently, a decrease in the rate of cell division.