Retroperitoneal endometriotic cyst: A case report

Hiroshi Ota, Masayuki Itô, Kaho Nagasawa, Koji Yamamoto, Hiroshi Maruoka, Toshiyuki Tsudo, Takashi Kato
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(2) , pp. 219–223 · doi:10.5180/jsgoe.38.2_219 · W4317923823
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This case report describes a 44-year-old woman with a retroperitoneal endometriotic cyst originating from the left broad ligament, diagnosed via MRI and confirmed histopathologically as a Type III cyst.

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This case report describes a 44-year-old woman presenting with left lower abdominal pain and an ovarian tumor. Surgical intervention revealed a retroperitoneal endometriotic cyst within the broad ligament, despite the absence of visible lesions in the peritoneum or uterine ligaments. Histopathological analysis confirmed the diagnosis, leading to the conclusion that Müllerian remnant metaplasia likely caused this rare Type III lesion. This paper is centrally about endometriosis — specifically the presentation and pathological classification of a retroperitoneal endometriotic cyst.

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Abstract

The peritoneum covering pelvic organs such as the uterine and ovarian ligaments and the pouch of Douglas is a common site of endometriosis, which is explained by the endometrial transplantation, peritoneal metaplasia, and the Müllerian remnant theories. The endometrial transplantation theory is widely accepted. We report a case of a retroperitoneal endometriotic cyst in a 44-year-old woman (gravida 4, para 2) who visited a local physician with a complaint of left lower abdominal pain and was referred to our hospital for further evaluation and treatment of a left ovarian tumor. Magnetic resonance imaging revealed a left ovarian endometriotic cyst measuring approximately 4.5 cm in size, and we performed laparoscopic left adnexectomy. Intraoperatively, the uterus appeared normal in size, and both ovaries were normal in appearance. We did not detect any endometriotic lesions in the peritoneum, in the uterine and ovarian ligaments, or in Douglas' pouch; however, a tumor (approximately 5 cm) was observed in the left broad ligament. The cyst had a thick wall, with dark brown and slightly viscous intracystic fluid. Histopathological findings were consistent with an endometriotic cyst, and the cyst wall showed fibrous tissue containing smooth muscle. Based on the classification of rectovaginal endometriosis proposed by Koninckx et al., the lesion was categorized as a Type III cyst, and metaplasia of Müllerian remnants was considered the likely pathogenetic contributor to the retroperitoneal cyst.
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症例報告 後腹膜腔に発生した子宮内膜症性嚢胞の１例 2022 年 38 巻 2 号 p. 219-223 詳細 抄録 The peritoneum covering pelvic organs such as the uterine and ovarian ligaments and the pouch of Douglas is a common site of endometriosis, which is explained by the endometrial transplantation, peritoneal metaplasia, and the Müllerian remnant theories. The endometrial transplantation theory is widely accepted. We report a case of a retroperitoneal endometriotic cyst in a 44-year-old woman (gravida 4, para 2) who visited a local physician with a complaint of left lower abdominal pain and was referred to our hospital for further evaluation and treatment of a left ovarian tumor. Magnetic resonance imaging revealed a left ovarian endometriotic cyst measuring approximately 4.5 cm in size, and we performed laparoscopic left adnexectomy. Intraoperatively, the uterus appeared normal in size, and both ovaries were normal in appearance. We did not detect any endometriotic lesions in the peritoneum, in the uterine and ovarian ligaments, or in Douglas' pouch; however, a tumor (approximately 5 cm) was observed in the left broad ligament. The cyst had a thick wall, with dark brown and slightly viscous intracystic fluid. Histopathological findings were consistent with an endometriotic cyst, and the cyst wall showed fibrous tissue containing smooth muscle. Based on the classification of rectovaginal endometriosis proposed by Koninckx et al., the lesion was categorized as a Type III cyst, and metaplasia of Müllerian remnants was considered the likely pathogenetic contributor to the retroperitoneal cyst. © 2022 日本産科婦人科内視鏡学会

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endometriosisbowel_endometriosis

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