Evaluation of ovarian endometriotic cysts by transvaginal sonography and videolaparoscopy

Transvaginal sonography made a preoperative diagnosis of ovarian endometriotic cyst in 45 women (age 20-45 yrs). The cyst was unilocular in 37 patients and multilocular in the rest. Intracystic projections were noted in seven. Doppler studies revealed benign ovarian masses. Videolaparoscopy was carried out to remove the ovarian cyst using a three-puncture technique. The cyst was aspirated before removal, which revealed chocolate material. Peritoneal or ovarian surface endometriotic lesions, with or without adhesions, associated with chocolate cysts were present in 35 women. Histopathologic examination of excised material revealed functional ovarian cysts in 12 patients, serous cystadenomas in 20, nonspecific ovarian cysts with fibrotic tissue in 4, and endometriotic cysts in 9. These results indicate that the majority of ovarian chocolate cysts are not true endometriomas but rather an association between endometriotic lesions and other neoplastic or functional ovarian cysts.