Decidualization of Ovarian Endometriosis During Pregnancy Mimicking Malignancy

Sammour, Rami N.; Leibovitz, Z.; Shapiro, I.; Degani, S.; Levitan, Z.; Aharoni, Ariel; Tal, J.; Lurie, M.; Ohel, Gonen

doi:10.7863/jum.2005.24.9.1289

Cited by 51 publications

(50 citation statements)

References 10 publications

(13 reference statements)

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“…Furthermore, both malignancy and deciduosis are characterized by marked vascularization as observed on color or power Doppler sonography, and both may produce similar ovarian cystic masses with an irregular internal surface with excrescences and solid components. 18 The decidualized tissue within the cysts undergoes thickening of the stroma and gains an extensive blood supply, thereby acquiring the sonographic appearance of a malignant pelvic tumor. 18 However, in our 2 cases, there was no or very little blood supply seen on color Doppler sonograms, suggesting that deciduosis may be characterized by a markedly lower degree of vascularization compared with ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

“…18 The decidualized tissue within the cysts undergoes thickening of the stroma and gains an extensive blood supply, thereby acquiring the sonographic appearance of a malignant pelvic tumor. 18 However, in our 2 cases, there was no or very little blood supply seen on color Doppler sonograms, suggesting that deciduosis may be characterized by a markedly lower degree of vascularization compared with ovarian cancer. Due to the hypertrophy of the ectopic endometrial stromal cells by decidual change during pregnancy, the diagnostic accuracy even of modern imaging modalities is limited, because functional decidual changes including contrast enhancement might be present.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this is the fifth report in the literature concerning ovarian deciduosis that was sonographically misdiagnosed as a malignant tumor. [15][16][17][18] Sonography is a simple and noninvasive modality for diagnosing ovarian tumor. 10 It will characteristically depict ovarian endometrioma as cystic structures with round-shaped homogeneous hypoechoic tissue of low-level echoes within the ovary and thick wall with regular margins.…”

Section: Discussionmentioning

confidence: 99%

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Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor

Yoshida

Onogi

Shinmoto

et al. 2008

J of Clinical Ultrasound

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor

Yoshida

Onogi

Shinmoto

et al. 2008

J of Clinical Ultrasound

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“…Decidualization occurs not only in the uterine but also in the extrauterine endometrium during pregnancy [1,4,6] , especially in endometrial stromal cells of ovarian endometriotic cysts [1,4] . This study revealed that decidualized ovarian endometriotic cysts showed papillary excrescences mimicking malignancy during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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

Machida

Matsubara

Ohwada

et al. 2008

Gynecol Obstet Invest

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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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“…Most of the available publications concerning the problem of scar endometriomas do not focus on the cesarean section itself (e.g. indications or obstetrical state before and during the cesarean section) [5,7,8,10,[27][28][29][30][31][32][33][34] , some specify the indications for the cesarean section [35] , while in others only simple elective cesarean section can be found [36] .…”

Section: Discussionmentioning

confidence: 99%

The Obstetrical History in Patients with Pfannenstiel Scar Endometriomas – An Analysis of 81 Patients

Wicherek¹,

Klimek²,

Skręt-Magierło³

et al. 2006

Gynecol Obstet Invest

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Introduction: The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. Materials and Methods: We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. Results: In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21–3.83; OR = 2.18, 95% CI = 1.22–3.89]. Conclusions: Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.

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Decidualization of Ovarian Endometriosis During Pregnancy Mimicking Malignancy

Abstract: This phenomenon is a diagnostic challenge and should be considered in the differential diagnosis of a malignant mass during pregnancy.

Cited by 51 publications

References 10 publications

Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor

Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor

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

The Obstetrical History in Patients with Pfannenstiel Scar Endometriomas – An Analysis of 81 Patients

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