Differential Diagnosis of Ovarian Tumors with Solid and Cystic Components: D. Imaging Diagnosis of Polypoid Endometriosis

Satomi Kitai
In: MRI and CT for Decision-Making in Obstetrics and Gynecology Practice · 2025 · pp. 85–91 · doi:10.1007/978-981-97-5120-4_9 · W4409830822
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This study describes the imaging diagnosis of a patient with an ovarian tumor presenting with solid and cystic components, specifically focusing on polypoid endometriosis as a differential diagnosis.

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This chapter focuses on imaging-based differential diagnosis of ovarian tumors that have both solid and cystic components, particularly in a patient scheduled for ovarian tumor surgery where transvaginal ultrasonography showed a cystic mass with a substantial area on the cyst wall suggesting a potentially solid lesion. It describes a decision pathway in which preoperative imaging is used to determine whether the lesion is benign versus malignant and to identify histological type, because staging surgery with retroperitoneal lymphatic dissection would be pursued only if ovarian cancer is diagnosed. A key limitation explicitly noted in the chapter context is that imaging findings must clarify diagnosis to guide management, implying diagnostic uncertainty when solid/cystic morphology overlaps between cancer and endometriosis-related conditions. Relevance to endometriosis: the chapter’s specific imaging diagnosis target is polypoid endometriosis of the ovary, discussed in the setting of mimicking ovarian carcinoma and informing differential diagnosis.

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Abstract

The patient was scheduled for ovarian tumor surgery. A cystic mass was revealed through transvaginal ultrasonography with a substantial area on the cyst wall indicating a potentially solid lesion. If the diagnosis is ovarian cancer, she is scheduled for staging surgery, including retroperitoneal lymphatic dissection. However, if it is a different tumor, lymphatic dissection will not be necessary. We decided to initially remove the ovarian tumor and subject it to an intraoperative rapid diagnosis. Our treatment planning depends on clarifying whether the ovarian tumor is benign or malignant, as well as establishing its histological type using preoperative imaging studies. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Kurman RJ, et al., editors. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC; 2014. Mostoufizadeh M, Scully RE. Malignant tumors arising in endometriosis. Clin Obstet Gynecol. 1980;23:951–63. Bazot M, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of the disease. Radiology. 2004;232:379–89. Corwin MT, et al. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 2014;271:126–32. Takeuchi M, et al. Case report: a case of polypoid endometriosis: MR pathological correlation. Br J Radiol. 2008;81:e118–9. Yamada Y, et al. Polypoid endometriosis of the ovary mimicking ovarian carcinoma dissemination: a case report and literature review. J Obstet Gynaecol Res. 2014;40:1426–30. Kurata Y, et al. Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour. Eur Radiol. 2017;27:1695–703. Kozawa E, et al. MR imaging of polypoid endometriosis of the ovary. Magn Reson Med Sci. 2012;11:201–4. Takeuchi M. A case of polypoid endometriosis with malignant transformation. Abdom Radiol. 2016;41:1699–702. Tanaka YO, et al. Ovarian carcinoma inpatients with endometriosis: MR imaging findings. AJR Am J Roentgenol. 2000;175:1423–30. McDermott S, et al. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics. 2012;32:845–63. Morisawa N, et al. Magnetic resonance imaging manifestations of decidualized endometriotic cysts: comparative study with ovarian cancers associated with endometriotic cysts. J Comput Assist Tomogr. 2014;38:879–84. Takeuchi M, et al. Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr. 2008;32:353–5. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. About this chapter Cite this chapter Kitai, S. (2025). Differential Diagnosis of Ovarian Tumors with Solid and Cystic Components: D. Imaging Diagnosis of Polypoid Endometriosis. In: Matsumura, N., Matsuki, M., Kido, A. (eds) MRI and CT for Decision-Making in Obstetrics and Gynecology Practice. Springer, Singapore. https://doi.org/10.1007/978-981-97-5120-4_9 Download citation DOI: https://doi.org/10.1007/978-981-97-5120-4_9 Published: Publisher Name: Springer, Singapore Print ISBN: 978-981-97-5119-8 Online ISBN: 978-981-97-5120-4 eBook Packages: MedicineMedicine (R0)

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endometriosis

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