Polypoid Endometriosis of the Cervix Mimicking a Uterine Malformation: Case Report

Kentaro Sekiyama, Saori Hata, Misao Shimizu, Yukio Yamanishi, Akiko Okuda, Miyuki Ito, Makoto Tokushige, Kenji Takakura
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2013 · vol. 29(2) , pp. 483–488 · doi:10.5180/jsgoe.29.483 · W2316021503
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This case report details a rare instance of polypoid endometriosis in a 16-year-old female that mimicked a uterine malformation on ultrasound but was accurately diagnosed by MRI and laparoscopic surgery.

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This case report describes a 16-year-old female presenting with severe dysmenorrhea and hypermenorrhea, initially suspected to have a uterine malformation based on transrectal ultrasound findings. Magnetic resonance imaging and subsequent laparoscopic surgery confirmed the diagnosis of polypoid endometriosis arising from the cervix and extending into the Pouch of Douglas, rather than a congenital anomaly. The patient’s symptoms resolved following surgical excision of the lesion, and she remained recurrence-free after eight months of oral contraceptive therapy. This paper is centrally about endometriosis — specifically a rare cervical variant known as polypoid endometriosis that mimics structural uterine defects in adolescent patients.

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Abstract

Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. It was first described by Mostoufizadeh and Scully in 1980. Polypoid endometriosis often forms large multiple masses and mimics malignant tumors. Endometriosis typically affects women of reproductive age; however, polypoid endometriosis commonly occurs in older women. We report a case of polypoid endometriosis that occurred in a very young female; it arose from the cervix and extended into the Pouch of Douglas. Although it mimicked a uterine malformation on ultrasound at patient presentation, a correct diagnosis was made by magnetic resonance imaging (MRI) and laparoscopic surgery. The patient is a 16-year-old nulliparous female with an intact hymen. One month prior to presentation at our hospital, she experienced severe lower abdominal pain, fever of 39° Celsius, and heavy menses with clots. This incident represented her first episode of dysmenorrhea and hypermenorrhea. The symptoms resolved spontaneously; however, one month later, she again experienced dysmenorrhea and presented at our facility. A uterine malformation such as a bicornuate uterus was suspected on transrectal ultrasound; however, MRI and laparoscopic surgery revealed polypoid endometriosis of the cervix. The symptoms resolved after excision of the lesion. Postoperatively, she has received oral contraceptive therapy for eight months; the condition has not recurred. When a uterine malformation is suspected on ultrasound, a rare condition such as polypoid endometriosis may be diagnosed by MRI or laparoscopic surgery.
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症例報告 初診時に子宮奇形を疑った子宮頸部polypoid endometriosisの一例 2013 年 29 巻 2 号 p. 483-488 詳細 抄録 Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. It was first described by Mostoufizadeh and Scully in 1980. Polypoid endometriosis often forms large multiple masses and mimics malignant tumors. Endometriosis typically affects women of reproductive age; however, polypoid endometriosis commonly occurs in older women. We report a case of polypoid endometriosis that occurred in a very young female; it arose from the cervix and extended into the Pouch of Douglas. Although it mimicked a uterine malformation on ultrasound at patient presentation, a correct diagnosis was made by magnetic resonance imaging (MRI) and laparoscopic surgery. The patient is a 16-year-old nulliparous female with an intact hymen. One month prior to presentation at our hospital, she experienced severe lower abdominal pain, fever of 39° Celsius, and heavy menses with clots. This incident represented her first episode of dysmenorrhea and hypermenorrhea. The symptoms resolved spontaneously; however, one month later, she again experienced dysmenorrhea and presented at our facility. A uterine malformation such as a bicornuate uterus was suspected on transrectal ultrasound; however, MRI and laparoscopic surgery revealed polypoid endometriosis of the cervix. The symptoms resolved after excision of the lesion. Postoperatively, she has received oral contraceptive therapy for eight months; the condition has not recurred. When a uterine malformation is suspected on ultrasound, a rare condition such as polypoid endometriosis may be diagnosed by MRI or laparoscopic surgery. © 2013 日本産科婦人科内視鏡学会

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