0
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      case-report
      1 , 2 , 3
      Journal of the Belgian Society of Radiology
      Ubiquity Press
      Endometriosis, magnetic resonance imaging (MRI), ovarian neoplasms, granulosa cell tumor, pelvis neoplasm

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          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.

          Related collections

          Most cited references8

          • Record: found
          • Abstract: not found
          • Article: not found

          Malignant tumors arising in endometriosis.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Polypoid endometriosis: a clinicopathologic analysis of 24 cases and a review of the literature.

            We describe 24 cases of polypoid endometriosis, most of which were referred because of problems in differential diagnosis, particularly distinction from a low-grade müllerian neoplasm. The patients were 23 to 78 years (mean 52.5 years) of age. Seven patients were on unopposed estrogen, four on combined estrogen-progestin therapy, and one patient had a synchronous ovarian thecoma. The most common clinical presentations were a pelvic mass, vaginal polypoid masses, and large bowel obstruction. In some cases, the intraoperative findings suggested a neoplasm. Sites of involvement in order of frequency included colon, ovary, uterine serosa, cervical and/or vaginal mucosa, ureter, fallopian tube, omentum, bladder, paraurethral and paravaginal soft tissue, and retroperitoneum. Multiple sites were involved in seven cases. Five cases occurred within ovarian or extraovarian endometriotic cysts. The lesions ranged up to 14 cm in size and formed polypoid, pink, gray or tan, masses. On microscopic examination, the polypoid masses were composed of an admixture of endometriotic glands and stroma. A variety of glandular architectural patterns were observed, sometimes in combination, most commonly cystic and noncystic simple hyperplasia, but also simple or complex hyperplasia with atypia, disordered proliferative, and cystic atrophy. Various types of epithelial metaplasia (tubal, mucinous, squamous, papillary syncytial metaplasia) were common. Hemorrhage, fibrosis, prominent thick-walled blood vessels, hemosiderin-laden histiocytes, and decidual change were also present in some cases. Eighteen cases were associated with usual (nonpolypoid) endometriosis. In one case, polypoid endometriosis merged with a mucinous borderline tumor of endocervical-type. In all but two cases, polypoid endometriosis lacked periglandular stromal hypercellularity, stromal atypia, and intraglandular stromal papillae, helping distinguish it from adenosarcoma. Focal intraglandular stromal papillae were noted in two cases with focal mild periglandular stromal hypercellularity in one of them, but no stromal atypia was present in either case. Follow-up data in 17 patients indicated that 15 patients were alive without evidence of residual disease, 1 was alive with residual endometriosis, and 1 died of other causes. In conclusion, polypoid endometriosis is a rare manifestation of endometriosis that may be mistaken for a neoplasm on clinical, intraoperative, or pathologic assessment. Some cases may be attributable to exogenous hormones or hyperestrinism and, like conventional endometriosis, some may evolve into a premalignant or, rarely, a neoplastic lesion. The main lesion in the differential is a müllerian (mesodermal) adenosarcoma.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Polypoid endometriosis: a mimic of malignancy.

              This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed findings consistent with polypoid endometriosis. After discontinuation of hormone replacement therapy, the mass showed decrease in size on follow-up imaging. Polypoid endometriosis is a rare but distinct variant of endometriosis with histopathologic features akin to an endometrial polyp. Clinical and imaging features of polypoid endometriosis differ from classic endometriosis. While classic endometriosis predominates in premenopausal women, polypoid endometriosis more commonly affects peri- to postmenopausal women and is associated with the exposure to Tamoxifen or hormone replacement therapy. Imaging features that aid in the diagnosis of polypoid endometriosis are a T2 hyperintense polypoid mass with signal characteristics similar to endometrium, a T2 hypointense peripheral rim, contrast enhancement pattern mirroring the enhancement of the endometrium, and lack of diffusion restriction. Radiologists should be familiar with polypoid endometriosis because this clinically and morphologically distinct variant may mimic malignant neoplasms on imaging.
                Bookmark

                Author and article information

                Contributors
                Journal
                J Belg Soc Radiol
                J Belg Soc Radiol
                2514-8281
                Journal of the Belgian Society of Radiology
                Ubiquity Press
                2514-8281
                2024
                13 February 2024
                : 108
                : 1
                : 14
                Affiliations
                [1 ]Medical imaging department, Hôpital Jean Bernard, Valenciennes, France
                [2 ]Gynaecological surgery department, Hôpital Jean Bernard, Valenciennes, France
                [3 ]Anatomical Pathology department, Hôpital Jean Bernard, Valenciennes, France
                Author notes
                CORRESPONDING AUTHOR: Emilie Demondion Medical imaging department, Hôpital Jean Bernard, Valenciennes, France emiliedemondion@ 123456yahoo.fr
                Author information
                https://orcid.org/0009-0002-2788-5868
                https://orcid.org/0000-0002-0521-9189
                Article
                10.5334/jbsr.3420
                10870938
                85472823-f38a-4119-a1d5-591b611cd1e1
                Copyright: © 2024 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

                History
                : 27 October 2023
                : 26 January 2024
                Categories
                Case Report

                endometriosis,magnetic resonance imaging (mri),ovarian neoplasms,granulosa cell tumor,pelvis neoplasm

                Comments

                Comment on this article