A case of polypoid endometriosis mimicking advanced ovarian carcinoma with rapid growth, invasion, and dissemination

Hiroyuki Yazawa, Riho Yazawa, Kaoru Fukuda, Miki Ohara
Fukushima journal of medical science · 2022 · vol. 68(3) , pp. 183–190 · doi:10.5387/fms.2022-23 · PMID:36288947 · W4307425310
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a rapidly growing polypoid endometriosis mimicking advanced ovarian cancer, initially treated with surgery and GnRH agonist, later responding to GnRH antagonist.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper is a 2022 case report describing rapidly progressive polypoid endometriosis that was initially misdiagnosed as advanced ovarian carcinoma. A 46-year-old woman underwent laparoscopic myomectomy and left adnexectomy after GnRH agonist treatment, and 11 months later developed rapid right ovarian enlargement with contrast-enhanced CT/MRI and PET-CT showing masses in multiple pelvic sites and increased uptake suggesting malignancy. After intestinal obstruction, colonoscopy found multiple polypoid sigmoid lesions, and biopsies from the omentum and right adnexa were diagnosed as polypoid endometriosis without malignancy on permanent pathology; the right adnexal tumor shrank markedly following GnRH antagonist therapy, with subsequent surgery confirming polypoid endometriosis extending from ovary to cecal mucosa. The paper’s limitation is that its conclusions are based on a single patient experience without a systematic comparison of diagnostic accuracy. This paper is centrally about endometriosis—polypoid endometriosis mimicking advanced ovarian cancer with rapid growth, invasion, and dissemination.

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Abstract

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present.Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification.
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Keywords

polypoid endometriosis, magnetic resonance imaging (MRI), PET-CT, differentiated diagnosis, endometriosis-associated malignancy 2022 Volume 68 Issue 3 Pages 183-190 Details

Abstract

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present. Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification. © 2022 The Fukushima Society of Medical Science This article is licensed under a Creative Commons [Attribution-NonCommercial-ShareAlike 4.0 International] license. https://creativecommons.org/licenses/by-nc-sa/4.0/ Favorites & Alerts Recently viewed articles

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Polyps Polyps

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