A rare case report of extensive abdominopelvic endometriosis mimicking peritoneal malignancy: an imaging investigation

Warissara Jutidamrongphan, Thorsang Chayovan, Teeravut Tubtawee, Keerati Hongsakul
In: Bali Medical Journal · 2020 · vol. 9(2) , pp. 582–586 · doi:10.15562/bmj.v9i2.1811 · W3103860840
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This case report details extensive abdominopelvic endometriosis that mimicked peritoneal malignancy on CT and MRI, requiring histological investigation for definitive diagnosis.

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This case report describes a 48-year-old woman whose extensive abdominopelvic endometriosis was initially misdiagnosed as peritoneal malignancy based on imaging findings of a large mass and hemoperitoneum. Although prior interventions for a suspected pelvic arteriovenous malformation had occurred, subsequent magnetic resonance imaging raised high suspicion for cancer, leading to surgical removal of the tumor. Histological examination ultimately confirmed the benign nature of the lesion, identifying it as endometriosis rather than a malignant process. This paper is centrally about endometriosis — specifically illustrating how extensive disease can mimic peritoneal malignancy on imaging studies.

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Abstract

Introduction: Endometriosis is a benign condition characterized by endometrial tissue deposited outside the uterine cavity. Endometriosis characteristics include a well-defined cyst (endometrioma) with or without internal septations and seeding nodules; however, no case of extensive infiltrating abdominopelvic endometriosis have been reported.Case presentation: A 48-year-old female presented with incidentally found a hypervascular lesion in the pelvic cavity from routine checkup ultrasound. The computed tomography (CT) angiography investigation showed pelvic arteriovenous malformation (AVM). She underwent embolization at interventional radiology unit and the CT angiography follow up showed complete occlusion of pelvic AVM. However, eight months after embolization, she came with severe abdominal pain and hypotension. Emergency CT showed a large abdominopelvic mass with hemoperitoneum which was suspected for gynecologic or peritoneal malignancy. Further magnetic resonance image (MRI) was highly suspicious of peritoneum or mesentery malignancy. Surgical tumor removal was performed. The histologic results were negative for malignancy and the tumor was compatible with endometriosis.Conclusion: Extensive abdominopelvic endometriosis is rare, and its imaging findings may not exclude peritoneal malignancy. Therefore, a definite diagnosis via histological investigation is necessary.Â
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Introduction

Endometriosis is a benign condition characterized by endometrial tissue deposited outside the uterine cavity. Endometriosis characteristics include a well-defined cyst (endometrioma) with or without internal septations and seeding nodules; however, no case of extensive infiltrating abdominopelvic endometriosis have been reported. Case presentation: A 48-year-old female presented with incidentally found a hypervascular lesion in the pelvic cavity from routine checkup ultrasound. The computed tomography (CT) angiography investigation showed pelvic arteriovenous malformation (AVM). She underwent embolization at interventional radiology unit and the CT angiography follow up showed complete occlusion of pelvic AVM. However, eight months after embolization, she came with severe abdominal pain and hypotension. Emergency CT showed a large abdominopelvic mass with hemoperitoneum which was suspected for gynecologic or peritoneal malignancy. Further magnetic resonance image (MRI) was highly suspicious of peritoneum or mesentery malignancy. Surgical tumor removal was performed. The histologic results were negative for malignancy and the tumor was compatible with endometriosis.

Conclusion

Extensive abdominopelvic endometriosis is rare, and its imaging findings may not exclude peritoneal malignancy. Therefore, a definite diagnosis via histological investigation is necessary.  - Chu YJ, Ryeom H, Lee SY, Kim GC, Cho SH, Lee J, et al. The diagnostic usefulness of ultrasound-guided peritoneal biopsy for the solitary peritoneal thickening of an unknown cause visualized as only infiltrated fat tissue on a CT scan. Journal of the Korean Society of Radiology. 2018;78(4):225–34. - Shanmuga Jayanthan S, Shashikala G, Arathi N. Perineal scar endometriosis. Indian Journal of Radiology and Imaging. 2019;29(4):457–61. - Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of endometriosis: Looking beyond the endometrioma with a dedicated protocol. RadioGraphics. 2019;39(5):1549–68. - Woodward PJ, Sohaey R, Mezzetti Jr TP. Endometriosis: radiologic-pathologic correlation. Radiographics. 2001;21(1):193–216. - Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, et al. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics. 2012;32(7):2031–43. - Krishnamurthy S, Balasubramaniam R. Role of imaging in peritoneal surface malignancies. Indian Journal of Surgical Oncology. 2016;7(4):441–52. - Coutinho Jr A, Bittencourt LK, Pires CE, Junqueira F, de Oliveira Lima CMA, Coutinho E, et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 2011;31(2):549–67. - Chamié LP, Blasbalg R, Pereira RMA, Warmbrand G, Serafini PC. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics. 2011;31(4):E77–100. - McDermott S, Oei TN, Iyer VR, Lee SI. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics. 2012;32(3):845–63. - Fiala L, Bob P, Raboch J. Oncological markers CA-125, CA 19-9 and endometriosis. Medicine (Baltimore). 2018;97(51):e13759. - Hanbidge AE, Lynch D, Wilson SR. US of the peritoneum. Radiographics. 2003;23(3):663–85. - Choudhary S, Fasih N, Papadatos D, Surabhi VR. Unusual imaging appearances of endometriosis. American Journal of Roentgenology. 2009;192(6):1632–44. - Pannu HK, Bristow RE, Montz FJ, Fishman EK. Multidetector CT of peritoneal carcinomatosis from ovarian cancer. Radiographics. 2003;23(3):687–701. - Gougoutas CA, Siegelman ES, Hunt J, Outwater EK. Pelvic endometriosis: various manifestations and MR imaging findings. American Journal of Roentgenology. 2000;175(2):353–8. - Bennett GL, Slywotzky CM, Cantera M, Hecht EM. Unusual manifestations and complications of endometriosis—spectrum of imaging findings: pictorial review. American Journal of Roentgenology. 2010;194(6):WS34–46. Jutidamrongphan, W., Chayovan, T., Tubtawee, T., & Hongsakul, K. (2020). A rare case report of extensive abdominopelvic endometriosis mimicking peritoneal malignancy: an imaging investigation. Bali Medical Journal, 9(2), 582–586. https://doi.org/10.15562/bmj.v9i2.1811 Warissara Jutidamrongphan Google Scholar Pubmed BMJ Journal Thorsang Chayovan Google Scholar Pubmed BMJ Journal Teeravut Tubtawee Google Scholar Pubmed BMJ Journal Keerati Hongsakul Google Scholar Pubmed BMJ Journal - Bali Medical Journal, Bali-Indonesia - +62 812-3999-2269 - +62 812-3999-2269 - [email protected] Copyright © DiscoverSys Inc

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