Decidualization of Ovarian Endometriosis during Pregnancy Mimicking Malignancy: Report of Three Cases with a Literature Review

Shizuo Machida, Shigeki Matsubara, Michitaka Ohwada, Manabu Ogoyama, Tomoyuki Kuwata, Takashi Watanabe, Akio Izumi, Mitsuaki Suzuki
Gynecologic and obstetric investigation · 2008 · vol. 66(4) , pp. 241–247 · doi:10.1159/000147171 · PMID:18645258 · W2032909473
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This report describes three pregnant women with decidualized ovarian endometriotic cysts exhibiting intracystic papillary excrescence, a feature mimicking malignancy, and reviews the literature on this uncommon phenomenon.

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Abstract

BACKGROUND: Intracystic papillary excrescence is a characteristic morphological feature of ovarian malignancy. A few recent reports have demonstrated that ovarian endometriotic cysts, undergoing decidualization during pregnancy, occasionally show excrescence, necessitating surgery during pregnancy; however, this phenomenon is not well recognized among clinicians. CASES: Three pregnant women with decidualized ovarian endometriosis showed excrescence. Both ultrasound and magnetic resonance imaging (MRI) preoperatively suggested the presence of underlying ovarian endometriotic cysts in 2 women, but not in the other. Intracystic papillary excrescence prompted us to perform laparotomy at 14, 14, and 19 weeks of pregnancy, respectively, with 1 woman aborting in the 21st week, and with 2 delivering healthy term infants. Histological examination confirmed the diagnosis of decidualized ovarian endometriotic cysts in all 3 patients. CONCLUSIONS: We provide the first report of pregnant women in whom excrescence occurred from ovarian endometriotic cysts without preoperative evidence. Decidualized ovarian endometriosis, even without preoperative morphological features of endometriosis, should be added to the differential diagnosis of ovarian malignancy during pregnancy.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Ovarian Cysts Pregnancy Complications, Neoplastic Adult Decidua Decidua Diagnosis, Differential Endometriosis Endometriosis Endometriosis Endometriosis Female Humans Ovarian Cysts Ovarian Cysts Ovarian Cysts Ovarian Cysts Pregnancy Pregnancy Complications, Neoplastic Pregnancy Complications, Neoplastic

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (13)

Cited by (24)

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