Endometrioma Tanısı ve Cerrahi Yönetimi
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This paper reviews the diagnosis and surgical management of endometriomas, referencing various studies on their pathogenesis, imaging, and treatment.
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The paper is a narrative-style overview focused on diagnosing endometrioma and discussing surgical management, drawing together evidence from reviews, consensus statements on sonographic evaluation, and imaging approaches (including color Doppler energy, MRI reporting/classifications) to structure how ovarian endometriomas are assessed and treated. It highlights common high-level diagnostic and management themes but provides limited original patient-level data, and it relies heavily on previously published literature and guidelines, which the authors do not uniformly quantify. A caveat is that the summarized evidence spans different modalities, populations, and time periods, so the degree to which findings directly generalize across settings is unclear. Relevance to endometriosis: the entire corpus topic is endometrioma within the broader endometriosis field, and the paper explicitly addresses endometrioma diagnosis and surgical management as part of endometriosis care.
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Endometrioma Tanısı ve Cerrahi Yönetimi
Özet
Referanslar
Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. Kasım 2019;15(11):666-82.
Busacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. Ağustos 2003;15(4):321-6.
Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A. Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review. J Ovarian Res. Aralık 2019;12(1):104.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, vd. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. Eylül 2016;48(3):318-32.
Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. Haziran 2017;96(6):633-43.
Exacoustos C, Zupi E, Piccione E. Ultrasound Imaging for Ovarian and Deep Infiltrating Endometriosis. Semin Reprod Med. 11 Ocak 2017;35(01):005-24.
Guerriero S, Ajossa S, Mais V, Risalvato A, Lai MP, Melis GB. The diagnosis of endometriomas using colour Doppler energy imaging. Hum Reprod. 01 Haziran 1998;13(6):1691-5.
Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. Temmuz 2014;28(5):655-81.
Van Holsbeke C, Van Calster B, Bourne T, Ajossa S, Testa AC, Guerriero S, vd. External Validation of Diagnostic Models to Estimate the Risk of Malignancy in Adnexal Masses. Clin Cancer Res. 01 Şubat 2012;18(3):815-25.
Thomassin-Naggara I, Dolciami M, Chamie LP, Guerra A, Bharwani N, Freeman S, vd. ESUR consensus MRI for endometriosis: indications, reporting, and classifications. Eur Radiol [Internet]. 27 Mayıs 2025 [a.yer 15 Haziran 2025]; Erişim adresi: https://link.springer.com/10.1007/s00330-025-11579-0
Glastonbury CM. The Shading Sign. Radiology. Temmuz 2002;224(1):199-201.
Maciel C, Ferreira H, Djokovic D, Kyaw Tun J, Keckstein J, Rizzo S, vd. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging. 05 Temmuz 2023;14(1):120.
Koninckx PR, Ussia A, Adamyan L, Tahlak M, Keckstein J, wattiez A, vd. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear. Best Pract Res Clin Obstet Gynaecol. Mart 2021;71:14-26.
Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, vd. ESHRE guideline: endometriosis. Hum Reprod Open. 04 Mart 2022;2022(2):hoac009.
Muzii L, Galati G, Mattei G, Chinè A, Perniola G, Di Donato V, vd. Expectant, Medical, and Surgical Management of Ovarian Endometriomas. J Clin Med. 26 Şubat 2023;12(5):1858.
Somigliana E, Vigano P, Filippi F, Papaleo E, Benaglia L, Candiani M, vd. Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod. 01 Haziran 2015;30(6):1280-6.
Working group of ESGE, ESHRE and WES, Saridogan E, Becker CM, Feki A, Grimbizis GF, Hummelshoj L, vd. Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma†‡¶. Hum Reprod Open. 01 Aralık 2017;2017(4):hox016.
Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. Ağustos 1999;72(2):310-5.
Ghezzi F, Raio L, Cromi A, Duwe DG, Beretta P, Buttarelli M, vd. “Kissing ovaries”: A sonographic sign of moderate to severe endometriosis. Fertil Steril. Ocak 2005;83(1):143-7.
Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril. Ağustos 2009;92(2):453-7.
Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, vd. ESHRE guideline: management of women with endometriosis. Hum Reprod. 01 Mart 2014;29(3):400-12.
Exacoustos C, Zupi E, Amadio A, Szabolcs B, De Vivo B, Marconi D, vd. Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue. Am J Obstet Gynecol. Temmuz 2004;191(1):68-72.
Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod. 01 Mart 1996;11(3):641-5.
Muzii L, Marana R, Angioli R, Bianchi A, Cucinella G, Vignali M, vd. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter? Fertil Steril. Mayıs 2011;95(6):2116-9.
Roman H. Laparoscopic Sclerotherapy of Large Endometriomas: Is It a Reasonable Approach? J Minim Invasive Gynecol. Eylül 2020;27(6):1223-4.
De Cicco Nardone A, Carfagna P, De Cicco Nardone C, Scambia G, Marana R, De Cicco Nardone F. Laparoscopic Ethanol Sclerotherapy for Ovarian Endometriomas: Preliminary Results. J Minim Invasive Gynecol. Eylül 2020;27(6):1331-6.
Crestani A, Merlot B, Dennis T, Roman H. Laparoscopic sclerotherapy for an endometrioma in 10 steps. Fertil Steril. Mayıs 2022;117(5):1102-3.
Ronsini C, Iavarone I, Braca E, Vastarella MG, De Franciscis P, Torella M. The Efficiency of Sclerotherapy for the Management of Endometrioma: A Systematic Review and Meta-Analysis of Clinical and Fertility Outcomes. Medicina (Mex). 11 Eylül 2023;59(9):1643.
Daniilidis A, Grigoriadis G, Kalaitzopoulos DR, Angioni S, Kalkan Ü, Crestani A, vd. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med. 16 Ağustos 2023;12(16):5324.
Referanslar
Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. Kasım 2019;15(11):666-82.
Busacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. Ağustos 2003;15(4):321-6.
Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A. Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review. J Ovarian Res. Aralık 2019;12(1):104.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, vd. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. Eylül 2016;48(3):318-32.
Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. Haziran 2017;96(6):633-43.
Exacoustos C, Zupi E, Piccione E. Ultrasound Imaging for Ovarian and Deep Infiltrating Endometriosis. Semin Reprod Med. 11 Ocak 2017;35(01):005-24.
Guerriero S, Ajossa S, Mais V, Risalvato A, Lai MP, Melis GB. The diagnosis of endometriomas using colour Doppler energy imaging. Hum Reprod. 01 Haziran 1998;13(6):1691-5.
Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. Temmuz 2014;28(5):655-81.
Van Holsbeke C, Van Calster B, Bourne T, Ajossa S, Testa AC, Guerriero S, vd. External Validation of Diagnostic Models to Estimate the Risk of Malignancy in Adnexal Masses. Clin Cancer Res. 01 Şubat 2012;18(3):815-25.
Thomassin-Naggara I, Dolciami M, Chamie LP, Guerra A, Bharwani N, Freeman S, vd. ESUR consensus MRI for endometriosis: indications, reporting, and classifications. Eur Radiol [Internet]. 27 Mayıs 2025 [a.yer 15 Haziran 2025]; Erişim adresi: https://link.springer.com/10.1007/s00330-025-11579-0
Glastonbury CM. The Shading Sign. Radiology. Temmuz 2002;224(1):199-201.
Maciel C, Ferreira H, Djokovic D, Kyaw Tun J, Keckstein J, Rizzo S, vd. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging. 05 Temmuz 2023;14(1):120.
Koninckx PR, Ussia A, Adamyan L, Tahlak M, Keckstein J, wattiez A, vd. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear. Best Pract Res Clin Obstet Gynaecol. Mart 2021;71:14-26.
Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, vd. ESHRE guideline: endometriosis. Hum Reprod Open. 04 Mart 2022;2022(2):hoac009.
Muzii L, Galati G, Mattei G, Chinè A, Perniola G, Di Donato V, vd. Expectant, Medical, and Surgical Management of Ovarian Endometriomas. J Clin Med. 26 Şubat 2023;12(5):1858.
Somigliana E, Vigano P, Filippi F, Papaleo E, Benaglia L, Candiani M, vd. Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod. 01 Haziran 2015;30(6):1280-6.
Working group of ESGE, ESHRE and WES, Saridogan E, Becker CM, Feki A, Grimbizis GF, Hummelshoj L, vd. Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma†‡¶. Hum Reprod Open. 01 Aralık 2017;2017(4):hox016.
Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. Ağustos 1999;72(2):310-5.
Ghezzi F, Raio L, Cromi A, Duwe DG, Beretta P, Buttarelli M, vd. “Kissing ovaries”: A sonographic sign of moderate to severe endometriosis. Fertil Steril. Ocak 2005;83(1):143-7.
Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril. Ağustos 2009;92(2):453-7.
Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, vd. ESHRE guideline: management of women with endometriosis. Hum Reprod. 01 Mart 2014;29(3):400-12.
Exacoustos C, Zupi E, Amadio A, Szabolcs B, De Vivo B, Marconi D, vd. Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue. Am J Obstet Gynecol. Temmuz 2004;191(1):68-72.
Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod. 01 Mart 1996;11(3):641-5.
Muzii L, Marana R, Angioli R, Bianchi A, Cucinella G, Vignali M, vd. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter? Fertil Steril. Mayıs 2011;95(6):2116-9.
Roman H. Laparoscopic Sclerotherapy of Large Endometriomas: Is It a Reasonable Approach? J Minim Invasive Gynecol. Eylül 2020;27(6):1223-4.
De Cicco Nardone A, Carfagna P, De Cicco Nardone C, Scambia G, Marana R, De Cicco Nardone F. Laparoscopic Ethanol Sclerotherapy for Ovarian Endometriomas: Preliminary Results. J Minim Invasive Gynecol. Eylül 2020;27(6):1331-6.
Crestani A, Merlot B, Dennis T, Roman H. Laparoscopic sclerotherapy for an endometrioma in 10 steps. Fertil Steril. Mayıs 2022;117(5):1102-3.
Ronsini C, Iavarone I, Braca E, Vastarella MG, De Franciscis P, Torella M. The Efficiency of Sclerotherapy for the Management of Endometrioma: A Systematic Review and Meta-Analysis of Clinical and Fertility Outcomes. Medicina (Mex). 11 Eylül 2023;59(9):1643.
Daniilidis A, Grigoriadis G, Kalaitzopoulos DR, Angioni S, Kalkan Ü, Crestani A, vd. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med. 16 Ağustos 2023;12(16):5324.
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