Decidualized Endometrioma During Pregnancy

Poder L, Liina Poder, Liina Pōder, Fergus V. Coakley, Coakley FV, Joseph T. Rabban, Rabban JT, Goldstein RB, Ruth B. Goldstein, Aziz S, Seerat Aziz, Chen LM, Lee-may Chen
Journal of computer assisted tomography · 2008 · vol. 32(4) , pp. 555–558 · doi:10.1097/rct.0b013e31814685ca · PMID:18664842 · W1980091458
article OA: closed CC0 ⤵ 24 in-corpus citations
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-09 ⓘ

Decidualized endometriomas mimicking ovarian cancer can be prospectively diagnosed during pregnancy by ultrasound and MRI findings of nodules similar to uterine decidua.

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This case report describes a 34-year-old pregnant woman whose ovarian endometrioma developed smooth, lobulated mural nodules with prominent internal vascularity during gestation. Magnetic resonance imaging revealed that these nodules shared striking signal intensity and texture similarities with the decidualized uterine endometrium, allowing for a prospective diagnosis of a decidualized endometrioma rather than ovarian malignancy. The authors conclude that recognizing this specific imaging pattern enables expectant management until postpartum resection confirms the benign nature of the lesion. This paper is centrally about endometriosis — specifically the rare phenomenon of decidualization within an existing endometrioma during pregnancy.

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Abstract

OBJECTIVE: To present the ultrasound and magnetic resonance imaging findings that may allow for a prospective diagnosis and expectant management of decidualized endometriomas because the rare occurrence of decidualization in the ectopic endometrial stroma of an endometrioma during pregnancy can mimic ovarian cancer at imaging. CASE REPORT: Smooth lobulated mural nodules with prominent internal vascularity were noted in an apparent right ovarian endometrioma on serial ultrasound studies in a 34-year-old woman at 12, 21, 27, and 30 weeks of gestation. Magnetic resonance imaging demonstrated the nodules to be strikingly similar in intensity and texture to the decidualized endometrium in the uterus on T2-weighted sequences. A provisional diagnosis of decidualized endometrioma allowed for expectant management with immediate postpartum resection and confirmation of the diagnosis. CONCLUSIONS: Decidualized endometrioma can mimic ovarian malignancy during pregnancy, but a prospective diagnosis may be possible when solid smoothly lobulated nodules with prominent internal vascularity within an endometrioma are seen from early in pregnancy, and the nodules demonstrate marked similarity in signal intensity and texture with the decidualized endometrium in the uterus at magnetic resonance imaging.
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Objective

To present the ultrasound and magnetic resonance imaging findings that may allow for a prospective diagnosis and expectant management of decidualized endometriomas because the rare occurrence of decidualization in the ectopic endometrial stroma of an endometrioma during pregnancy can mimic ovarian cancer at imaging. Case Report: Smooth lobulated mural nodules with prominent internal vascularity were noted in an apparent right ovarian endometrioma on serial ultrasound studies in a 34-year-old woman at 12, 21, 27, and 30 weeks of gestation. Magnetic resonance imaging demonstrated the nodules to be strikingly similar in intensity and texture to the decidualized endometrium in the uterus on T2-weighted sequences. A provisional diagnosis of decidualized endometrioma allowed for expectant management with immediate postpartum resection and confirmation of the diagnosis.

Conclusions

Decidualized endometrioma can mimic ovarian malignancy during pregnancy, but a prospective diagnosis may be possible when solid smoothly lobulated nodules with prominent internal vascularity within an endometrioma are seen from early in pregnancy, and the nodules demonstrate marked similarity in signal intensity and texture with the decidualized endometrium in the uterus at magnetic resonance imaging.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Ovarian Neoplasms Pregnancy Complications Ultrasonography, Doppler Adult Diagnosis, Differential Endometriosis Endometriosis Female Follow-Up Studies Humans Magnetic Resonance Imaging Ovarian Neoplasms Ovary Ovary Ovary Ovary Pregnancy Pregnancy Complications

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (17)

Cited by (26)

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