P34.11: Endometriosis in posterior fornix of the vagina diagnosed by transvaginal ultrasonography by free hand real‐time elastography: a case report

Extrapelvic endometriosis can occur in up to 12% of cases. The symptoms are generally related to menstruation. Vaginal localizations of endometriosis is very rare form of extrapelvic endometriosis, occurring in up to 1.00% of cases. The patient was a 31-year old woman, multiparous, regularly menstruating. She had spotting in the luteal phase of the menstrual cycle. She reported dysmenorrhea and dyspareunia in last two years. In gynecological exploration was observed a solitary lesion in posterior fornix of vagina. Bimanual examination revealed anteverted and normal-sized uterus. Uterosacral ligaments, both ovaries, cul-de-sac, and other peritoneal reflections were normal. The cervix was normal in appearance. Serum biochemistry was normal with the exception of elevated levels of CA-125 - 43U/ml. The two-dimensional (2D) transvaginal ultrasonography showed a 5-mm hypoechogenic, heterogeneous lesion with irregular shape borders, localized in posterior fornix of the vagina. Free hand real time elastography showed a 11 mm finding with high index of strain. A needle aspiration biopsy was performed. In histologic examination endometrial gland and stroma, fibrosis and hemosiderin deposits were seen. Transvaginal free hand real-time elastography is a useful, noninvasive tool in diagnosis of extrapelvic localizations of endometriosis. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.