EP25.16: Vascularisation of endometriomas: a case series

Ovarian endometriomas are thought to originate from invagination of the ovarian cortex around an endometriotic deposit. Pelvic pain and infertility are known concerns in women with endometriosis. Ovarian epithelial malignancy is another important consideration; clear cell and endometrioid subtypes, and their precursors – borderline ovarian tumours (BOTs) – have been linked to endometriosis. Pre-operative sonographic evaluation of BOTs is challenging, with correct classification in only 29-69% of cases, particularly in patients with endometriosis. Doppler assessment of vascularity of the entire tumour and solid aspects has been shown to improve the ability to correctly diagnose pelvic masses. Sonographic vascularity of endometriomas in pregnancy, a result of decidualisation, can mimic ovarian malignancy and pose diagnostic challenges for healthcare providers6, 7. This case series aims to highlight the importance of identifying vascularity in endometriomas and the implications in pregnant and non-pregnant patients. We will present the clinical history, sonographic findings, and management of three patients with endometriosis whose sonographic findings, including vascularisation, elicited concern for malignancy. The outcomes included two patients with BOTs and one patient with a decidualised endometrioma in pregnancy.