Imaging Diagnosis of Decidualized Endometriotic Cysts

In: MRI and CT for Decision-Making in Obstetrics and Gynecology Practice · 2025 · pp. 353–360 · doi:10.1007/978-981-97-5120-4_38 · W4409830639
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This paper explores how MRI can differentiate between decidualized ovarian endometriotic cysts and ovarian cancer during pregnancy, as ultrasound findings can be ambiguous and lead to different management strategies.

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This case report describes a 36-year-old pregnant woman with a history of an ovarian chocolate cyst, whose ultrasound revealed solid components and enhancement that raised suspicion for ovarian cancer. The authors highlight the critical diagnostic challenge of distinguishing decidualized endometriotic cysts from malignancies to avoid unnecessary surgical intervention during pregnancy. While standard protocols for suspected cancer involve termination and extensive surgery, recognizing decidualization allows for conservative monitoring, though the text notes persistent questions regarding MRI differentiation. This paper is centrally about endometriosis — specifically the imaging diagnosis of decidualized endometriotic cysts in pregnant patients.

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Abstract

A 36-year-old woman, 12 weeks pregnant, was previously diagnosed with an ovarian chocolate cyst. A transvaginal ultrasound scan detected a solid tissue component and an enhanced area within the cyst, raising suspicions of ovarian cancer. The standard protocol for confirmed ovarian cancer is to terminate the pregnancy and perform extensive ovarian cancer surgery. Conversely, if it is a case of decidualization of the ovarian chocolate cyst, monitoring without surgery is advised. An unanswered question persists: How can MRI discern between the two conditions? Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Ray JG, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316:952–61. Poder L, et al. Decidualized endometrioma during pregnancy: recognizing an imaging mimic of ovarian malignancy. J Comput Assist Tomogr. 2008;32:555–8. Sammour RN, et al. Decidualization of ovarian endometriosis during pregnancy mimicking malignancy. J Ultrasound Med. 2005;24:1289–94. Miyakoshi K, et al. Decidualized ovarian endometriosis mimicking malignancy. AJR Am J Roentgenol. 1998;171:1625–6. Takeuchi M, et al. Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr. 2008;32:353–5. Morisawa N, et al. Magnetic resonance imaging manifestations of decidualized endometriotic cysts: comparative study with ovarian cancers associated with endometriotic cysts. J Comput Assist Tomogr. 2014;38:879–84. Takewa M, et al. Uterine myoma and endometrioid cyst. Jpn J Imaging Diagn. 2012;32:435–44. Japanese. Tanaka YO, et al. A decidualized endometrial cyst in a pregnant woman: a case observed with a steady-state free precession imaging sequence. Magn Reason Imaging. 2002;20:301–4. Tanaka YO, et al. MRI of endometriotic cysts in association with ovarian carcinoma. AJR Am J Roentgenol. 2010;194:355–61. Tanaka Y. Endometriosis and related diseases 4 complications. In: Diagnostic imaging in obstetrics and gynecology. 1st ed. Tokyo: Kanahara Shuppan. p. 580–92. Japanese. Kurata Y, et al. Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumor from endometriosis-related malignant ovarian tumor. Eur Radiol. 2017;27:1695–703. Tsuno A, et al. Decidualization attenuates the contractility of eutopic and ectopic endometrial stromal cells: implications for hormone therapy of endometriosis. J Clin Endocrinol Metab. 2009;94:2516–23. Shuri E, et al. A case of chocolate cyst desquamation with malignant transformation during Dienogest use. Okinawa Obstet Gynecol. 2011;33:96–100. Japanese. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. About this chapter Cite this chapter Takewa, M. (2025). Imaging Diagnosis of Decidualized Endometriotic Cysts. In: Matsumura, N., Matsuki, M., Kido, A. (eds) MRI and CT for Decision-Making in Obstetrics and Gynecology Practice. Springer, Singapore. https://doi.org/10.1007/978-981-97-5120-4_38 Download citation DOI: https://doi.org/10.1007/978-981-97-5120-4_38 Published: Publisher Name: Springer, Singapore Print ISBN: 978-981-97-5119-8 Online ISBN: 978-981-97-5120-4 eBook Packages: MedicineMedicine (R0)

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