OP21.08: Decidualized hypervascularized ovarian endometrioma in pregnancy: can it be distinguished from cancer to avoid surgery?

In most instances the finding of a richly vascularized ovarian lesion in pregnancy is considered malignant and the patient is almost invariably subjected to surgical exploration and removal of the ovary. This may lead to miscarriage and/or premature delivery. There is a specific situation in which in spite of the exuberant richness of blood vessels in the ovary of a pregnant patient the lesion is not malignant. A decidualized endometrioma presents such a situation. The objective was to study the possibility to define characteristics of such lesions to ensure a correct diagnosis. Relying on ultrasound imaging of the adnexal masses in 2 cases of ovarian cancer and 2 cases of decidualized endometriomas in pregnancy we propose guidelines to differentiate between malignant and the benign features of the above lesions. In addition to the history, grayscale 2D imaging we used the determination of ovarian vascularity using the virtual organ computer-aided analysis (VOCAL®) of Kretz-GE software generated flow indices. Are shown in the table below The sonographic characteristics of decidualized endometriomas in pregnancy were defined. An in-depth history (possibly examining previous ultrasound images), grayscale as well as 3D ultrasound using 3D color Doppler angiography may differentiate a malignant lesion from the above mentioned benign lesion of the ovary. Such a differentiation may avoid unnecessary abdominal surgery in pregnancy.