Decidualized endometrioma

Pearls and Pitfalls in Abdominal Imaging Buy print or eBook [Opens in a new window] Pseudotumors, Variants and Other Difficult Diagnoses - Frontmatter - Contents - Preface - Acknowledgements - Section 1 Diaphragm and adjacent structures - Section 2 Liver - Section 3 Biliary system - Section 4 Spleen - Section 5 Pancreas - Section 6 Adrenal glands - Section 7 Kidneys - Section 8 Retroperitoneum - Section 9 Gastrointestinal tract - Section 10 Peritoneal cavity - Section 11 Ovaries - Case 72 Corpus luteum cyst - Case 73 Peritoneal inclusion cyst - Case 74 Adnexal pseudotumor due to exophytic uterine fibroid - Case 75 Malignant transformation of endometrioma - Case 76 Ovarian transposition - Case 77 Massive ovarian edema - Case 78 Decidualized endometrioma - Section 12 Uterus and vagina - Section 13 Bladder - Section 14 Pelvic soft tissues - Section 15 Groin - Section 16 Bone - Index - References from Section 11 - Ovaries Published online by Cambridge University Press: 05 November 2011 Book contents - Frontmatter - Contents - Preface - Acknowledgements - Section 1 Diaphragm and adjacent structures - Section 2 Liver - Section 3 Biliary system - Section 4 Spleen - Section 5 Pancreas - Section 6 Adrenal glands - Section 7 Kidneys - Section 8 Retroperitoneum - Section 9 Gastrointestinal tract - Section 10 Peritoneal cavity - Section 11 Ovaries - Case 72 Corpus luteum cyst - Case 73 Peritoneal inclusion cyst - Case 74 Adnexal pseudotumor due to exophytic uterine fibroid - Case 75 Malignant transformation of endometrioma - Case 76 Ovarian transposition - Case 77 Massive ovarian edema - Case 78 Decidualized endometrioma - Section 12 Uterus and vagina - Section 13 Bladder - Section 14 Pelvic soft tissues - Section 15 Groin - Section 16 Bone - Index - References Imaging description Decidualization is the physiological transformation of endometrial tissue into the dense highly vascularized cellular matrix known as decidua that occurs in the endometrium of the uterus during pregnancy [1]. The same process can occur in the ectopic endometrium within endometriomas, and may result in the development of solid nodules in endometriomas during pregnancy (Figure 78.1). Importance Decidualization of endometriomas may be misdiagnosed as ovarian cancer or malignant transformation, resulting in unnecessary surgery during pregnancy. Typical clinical scenario Adnexal masses (excluding physiological corpus luteal cysts of early pregnancy) are seen in 0.5 to 1.2% of pregnancies, and 11% of these are endometriomas [2]. Despite the relative frequency of endometriomas in pregnancy, decidualization resulting in an appearance that mimics malignancy seems rare, with only a handful of reported cases [3–7]. Most of these cases have resulted in surgery during pregnancy because of the suspicious imaging findings [3–7]. Differential diagnosis The development of solid nodules in an endometrioma could also indicate superimposed malignancy. While malignant transformation of an endometrioma during pregnancy has not been reported, this remains a potential concern when solid nodules develop within an endometrioma irrespective of whether the patient is pregnant or not. - Type - Chapter - Information - Pearls and Pitfalls in Abdominal ImagingPseudotumors, Variants and Other Difficult Diagnoses, pp. 270 - 271Publisher: Cambridge University PressPrint publication year: 2010 Pregnancy-associated ectopic decidua. Am J Surg Pathol 1987; 11: 526–530.CrossRefGoogle ScholarPubMed , . Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med 1997; 16: 447–452.CrossRefGoogle ScholarPubMed , . Decidualized ovarian endometriosis mimicking malignancy. Am J Roentgenol 1998; 171: 1625–1626.CrossRefGoogle ScholarPubMed , , , et al. A decidualized endometrial cyst in a pregnant woman: a case observed with a steady-state free precession imaging sequence. Magn Reson Imaging 2002; 20: 301–304.CrossRefGoogle Scholar , , , et al. Sonographic features of decidualized ovarian endometriosis suspicious for malignancy. Ultrasound Obstet Gynecol 2004; 24: 578–580.CrossRefGoogle ScholarPubMed , , , et al. Decidualization of ovarian endometriosis during pregnancy mimicking malignancy. J Ultrasound Med 2005; 24: 1289–1294.CrossRefGoogle ScholarPubMed , , , et al. Case study of a pregnant woman with decidualized ovarian endometriosis whose preoperative findings suggested malignant transformation. Eur J Gynaecol Oncol 2006; 27: 301–303.Google ScholarPubMed , , , et al. Decidualized endometrioma during pregnancy: recognizing an imaging mimic of ovarian malignancy. J Comput Assist Tomogr 2008; 32: 555–558.CrossRefGoogle ScholarPubMed , , , et al. Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. 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