Complex abdominopelvic endometriosis: the radiologist’s perspective

Endometriosis is a multifocal gynecological disorder affecting approximately 6%–10% of women during their reproductive years (Giudice and Kao in: Lancet 364:1789–1799, 2004). Presenting symptomatology often relates to the anatomical structures involved. Given the complexity of both the management and pain control of patients with complex endometriosis, the British Society of Gynaecological Endoscopy has issued guidelines on the establishment of a multidisciplinary team approach to these cases (http://www.bsge.org.uk/ec-requirements-BSGE-accredited-endometriosis-centre.php). The ovaries are the most common site affected, but the gastrointestinal, genitourinary tract, chest and other soft tissues are not infrequently involved. Less well-recognized features of the disease include the deep infiltrative form of endometriosis, malignant transformation and decidualization of endometriomas under progesterone. In this pictorial essay, we will discuss the clinical presentation and review the imaging features of these complex and under appreciated forms of endometriotic disease. Similar content being viewed by others

Giudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799 Eskanazi B, Warner M (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24:235–258 Cramer DW (1987) Epidemiology of endometriosis in adolescents. In: Wilson EA (ed) Endometriosis. New York: Alan Liss, pp 5–8 Coutinho A Jr, Bittencourt LK, Pires CE, et al. (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. RadioGraphics 31(2):549–567 Cottier J, Descamps P, Sonier CB (1995) Sciatic endometriosis: MR evaluation. AJNR 16:1399–1401 Woodward PJ, Sohaey R, Mazzetti TP (2001) Endometriosis radiologic-pathologic correlation. Radiographics 21:193–216 Augoulea A, Lambrinoudaki I, Christodoulakos G (2008) Thoracic endometriosis syndrome. Respiration 75:113–119 http://www.bsge.org.uk/ec-requirements-BSGE-accredited-endometriosis-centre.php Olive DL, Schwartz LB (1993) Endometriosis. N Eng J Med 328:1759–1769 Sourial S, Tempest N, Hapangama DK (2014) Theories on the pathogenesis of endometriosis. In J Reprod Med 2014:9, Article ID 179515 Sampson JA (1927) Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 14:442–469 Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM (1984) Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol 64:151–154 Iwanoff N (1898) Dusiges cystenhaltiges uterusfibromyom compliciert durch sarcom und carcinom. (Adenofibromyoma cysticum sarcomatodes carcinomatosum). Monatsch Geburtshilfe Gynakol 7:295–300 Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P (2002) High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 17(10):2715–2724 Clement PB (1994) Diseases of the peritoneum. In: Kurman RJ (ed) Blaustein’s pathology of the female genital tract, 4th edn. New York: Springer, pp 660–680 Kumar V, Abbas AK, Fausto NF, Aster JC (2010) The female genital tract: in Robbins pathological basis of disease, 8th edn. Philadelphia: Saunder Elsevier, p 1029 Bennett GL, Slywotzky CM, Cantera M, Hecht EM (2010) Unusual manifestations and complications of endometriosis-spectrum of imaging findings: pictorial review. AJR Am J Roengenol 194(6):WS34–WS46 Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691 Asch E, Levine D (2007) Variations in appearance of endometriomas. J Ultrasound Med 26:993–1002 Gougoutas CA, Siegelman ES, Hunt J, Outwater EK (2000) Pelvic Endometriosis: various manifestations ad MR imaging findings. AJR 175:353–358 Bates J (1997) Pathology of the uterus, cervix and vagina. In: Bates J (ed) Practical gynecological ultrasound, 1st edn. London: Greenwich Medical Media, p 69 Fedele L, Biacnhi S, Dorta M, et al. (1992) Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. FertilSteril 58:94–97 Ott DJ, Fayez JA, Zagoria RJ (1991) Tubal and adnexal abnormalities. In: Ott DJ, Fayez JA (eds) Hysterosalpingography: a text and atlas. Baltimore: Urban & Schwarzenberg, pp 103–125 Rezvani M, Shabaan AM (2011) Fallopian tube disease in the non pregnant patient. RadioGraphics 31(2):527–548 Outwater EK, Siegelman ES, Chiowanich P (1998) Dilated fallopian tubes: MR imaging characteristics. Radiology 208(2):463–469 Kim MY, Rha SE, Oh SN, et al. (2009) MR imaging findings of hydrosalpinx: a comprehensive review. RadioGraphics 29(2):495–507 De Bree E, Schoretsanitis G, Melissas J, Christodoulakis M, Tsiftsis D (1998) Acute intestinal obstruction caused by endometriosis mimicking sigmoid carcinoma. Acta Gastroenterol Belg 61:376–378 Gard NK, Bagul NB, Doughan S, Rowe PH (2009) Intestinal endometriosis—a rare cause of colonic perforation. World J Gastroenterol 15(5):612–614 Gedgaudas-McClees RK (1994) Gastrointestinal complications of gynecologic diseases. In: Gore RM, Levine MS, Laufer I (eds) Textbook of gastrointestinal radiology. Philadelphia: Saunders, pp 2559–2567 Gustofson RL, Kim N, Liu S, Stratton P (2006) Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril 86:298–303 Mittal VK, Chouldhury SP, Cortez JA (1981) Endometriosis of the appendix presenting as acute appendicitis. Am J Surg 142:519–521 Matthew HR, James A, Sukumar S. Mucocele of the appendix: a pictorial review. Poster present at ECR 2015, Vienna, Austria. doi 10.1594/ecr2015/C-1344 Markham SM, Carpenter SE, Rock JA (1989) Extrapelvic endometriosis. Obstet Gynecol Clin North Am 16:193–219 Manikandan R, Pollard A, Pritchard S, Adeyoju A (2004) Vesical endometriosis. J Obstet Gynecol 24:327 Vercellini P, Frontino G, Pisacreta A (2002) The pathogenesis of bladder detrusor endometriosis. Am J Obstet Gynecol 187(3):538–542 Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ (2006) Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radio-Graphics 26(6):1847–1868 Choudhary S, Fasih N, Papadatos D, Surabhia VR (2009) Unusual imaging appearances of endometriosis. AJR 192:1643–1644 Abrao MS, Dias JA Jr, Bellelis P, et al. (2009) Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril 91(5):1662–1667 Kane C, Drouin P (1985) Obstructive uropathy associated with endometriosis. Am J Obstet Gynecol 151(2):207–211 Stillwell TJ, Kramer SA, Lee RA (1986) Endometriosis of ureter. Urology 28(2):81–85 Dwivedi AJ, Agrawal SN, Silva YJ (2002) Abdominal wall endometriomas. Dig Dis Sci 47:456–461 Granese R, Cucinella G, Barresi V, et al. (2009) Isolated endometriosis on the rectus abdominis muscle in women without a history of abdominal surgery: a rare and intriguing finding. J Minim Invasive Gynecol 16(6):798–801 Yu CY, Perez-Reyes M, Brown JJ, Borrello JA (1994) MR appearance of umbilical endometriosis. J Comput Assist Tomogr 18(2):269–271 Takeuchi M, Matsuzaki K, Nishitani H (2008) Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr 32(3):353–355 Machida S, Matsubara S, Ohwada M, et al. (2008) Decidualization of ovarian endometriosis during pregnancy mimicking malignancy: report of three cases with a literature review. Gynecol Obstet Invest 66:241–247 Takeuchi M, Matsuxaki K, Uehara H, Nishitani H (2007) MR manifestations of decidualized endometrial cysts during pregnancy. Pro Int Soc Magn Reson Med 15:578 Heaps JM, Nieverg RK, Berek JS (1990) Malignant neoplasms arising in endometriosis. Obstet Gynecol 75:1023–1028 McDermott S, Oei TN, Iyer VR, Lee SI (2012) MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. RadioGraphics 32(3):845–863 Tanaka YO, Yoshizako T, Nishida M, et al. (2000) Ovarian carcinoma in patients with endometriosis: MR imaging findings. AJR Am J Roentgenol 175:1423–1430 Takeuchi M, Matsuzaki K, Uehara H, Nishitani H (2006) Malignant transformation of Pelvic Endometriosis: MR Imaging findings and pathological correlation. Radiographics 26:407–417 Acknowledgments We would like to thank Dr Paula Hyder, Consultant Histopathologist at our instituition, for her help with Figures 16 and 18. The Medical Illustrations department at Central Manchester Foundation Trust kindly provided Figure 1 for publication. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Barrow, T.A., Elsayed, M., Liong, S.Y. et al. Complex abdominopelvic endometriosis: the radiologist’s perspective. Abdom Imaging 40, 2541–2556 (2015). https://doi.org/10.1007/s00261-015-0413-0 Published: Issue date: DOI: https://doi.org/10.1007/s00261-015-0413-0