Vaginal polypoid endometriosis in a woman in her 30s with advanced pelvic endometriosis: A case report and literature review

Vishal Bahall, Lance De Barry
Case reports in women's health · 2025 · vol. 48 , pp. e00768 · doi:10.1016/j.crwh.2025.e00768 · PMID:41362446 · PMC12681565 · W4416418596
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This case report describes a 36-year-old woman with advanced endometriosis who presented with vaginal bleeding, and was diagnosed with polypoid endometriosis of the vagina, a rare condition mimicking neoplasms.

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Abstract

Polypoid endometriosis is a remarkably rare variant of endometriosis that may clinically and morphologically mimic benign or malignant neoplasms. Vaginal involvement is particularly uncommon and can pose diagnostic challenges due to its atypical presentation. Recognition of this clinical entity is crucial, especially in women with advanced pelvic endometriosis and a history of abnormal vaginal bleeding. This report concerns the case of a 36-year-old woman with a known history of stage IV endometriosis who presented with intermenstrual bleeding, postcoital bleeding, secondary infertility and chronic abdominal pain. Clinical assessment revealed a left-sided mass arising from pelvis and multiple polypoid masses that was just visible posterior to cervix. Pelvic ultrasonography revealed bilateral endometriomas and an endometrial polyp. She was scheduled for laparoscopic cystectomy, hysteroscopic polypectomy and removal of polypoid vaginal polyp. Excisional biopsy of the lesion demonstrated endometrial glands and stroma within fibrotic tissue consistent with vaginal polypoid endometriosis. This case adds to the limited body of literature describing polypoid endometriosis of the vagina. It underscores the importance of careful, individualized decision-making for treatment, particularly for young women desirous of fertility preservation. • Polypoid endometriosis is a remarkably rare histopathological variant of endometriosis that can closely mimic benign or malignant neoplasms. • Vaginal involvement represents one of the rarest localizations, with only a handful of cases reported in the literature. • Risk factors include prior pelvic surgery in patients with advanced endometriosis, hyperestrogenism and tamoxifen use. • Histopathological examination remains the gold standard for diagnosis, distinguishing polypoid endometriosis from vaginal adenosis or neoplastic lesions. • Complete excision of the lesion is curative in most cases, and fertility-preserving management should be prioritized in younger patients.

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endometriosisinfertility

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