Isolated Ovarian Endometrioma: A History Between Myth and Reality

Exacoustos C, Caterina Exacoustos, C. Exacoustós, De Felice G, Giovanna De Felice, G. De Felice, Alessandra Pizzo, Pizzo A, Morosetti G, Giulia Morosetti, G. Morosetti, Lucia Lazzeri, Gabriele Centini, Emilio Piccione, Piccione E, Zupi E, Errico Zupi
Journal of Minimally Invasive Gynecology · 2018 · vol. 25(5) , pp. 884–891 · doi:10.1016/j.jmig.2017.12.026 · PMID:29353008 · W2783826270
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This paper explores the historical understanding and classification of isolated ovarian endometriomas, tracing their conceptualization from obscure references to their current recognition as a distinct clinical entity.

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Abstract

Study objectiveTo assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extraovarian lesions including adhesions, deep infiltrating endometriosis (DIE), and adenomyosis.DesignRetrospective observational study (Canadian Task Force classification II-2).SettingTwo university hospitals.PatientsTwo hundred fifty-five symptomatic women with at least 1 ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation.InterventionsPatients underwent TVS followed by either medical or surgical treatment.Measurements and main resultsTwo hundred fifty-five women, aged 20 to 40 years, underwent TVS and were found to have at least 1 endometrioma with a diameter > 20 mm. Associated sonographic signs of pelvic endometriosis (adhesions, DIE, and adenomyosis) were recorded, and a subgroup of patients (n = 50) underwent laparoscopic surgery within 3 months of TVS. Mean endometrioma diameter was 40.0 ± 18.1 mm, and bilateral endometriomas were observed in 65 patients (25.5%). TVS showed posterior rectal DIE in 55 patients (21.5%) and a thickening of at least 1 uterosacral ligament in 93 patients (36.4%). One hundred eighty-six patients (73%) had adhesions, and 134 patients (53%) showed signs of myometrial adenomyosis on TVS. Thirty-eight patients (15%) exhibited only a single isolated endometrioma with a mobile ovary and no other signs of pelvic endometriosis/adenomyosis at TVS.ConclusionOvarian endometriomas are indicators for pelvic endometriosis and are rarely isolated. Particularly, left endometriomas were found to be associated with rectal DIE and left uterosacral ligament localization and bilateral endometriomas correlated with adhesions and pouch of Douglas obliteration, whereas no correlation was found between endometrioma size and DIE. Determining appropriate management, whether clinical or surgical, is critical for ovarian endometriomas and concomitant adhesions, endometriosis, and adenomyosis in patients desiring future fertility.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Adenomyosis Adenomyosis Adult Endometriosis Endometriosis Endometriosis Female Humans Laparoscopy Myometrium Myometrium Ovary Ovary Peritoneal Diseases Peritoneal Diseases Retrospective Studies Tissue Adhesions Tissue Adhesions Ultrasonography

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