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

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.

Large Pancreatic Mucinous Cystic Neoplasm during Pregnancy: What Should Be Done?

“…For this reason, an appropriate diagnosis is mandatory, but the differentiation of a mucinous from a nonmucinous cyst and, especially, the quantification of its malignant potential, are very difficult tasks because all imaging techniques, including MRI, have been inconsistent [14,15,16]. It is estimated that MRI only has an accuracy that varies between 20 and 80% [17].…”

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

“…Each of our patients avoided the complication of surgery and obtained a spontaneous pregnancy that finally resulted in a positive effect on both symptomatology and endometriotic lesions. Previous authors have observed the sonographic characteristics of decidualized, hypervascularized endometriomas during pregnancy [22][23][24][25][26][27] but this is the first report on ultrasound pattern modification of DIE occurring during a spontaneous pregnancy.…”

Macroscopic deciduosis in pregnancy is finally a common entity

“…In the current literature, the presence of ovarian deciduosis is reported as a rare phenomenon [15,16]. With 10.1% of Cesarean sections presenting deciduosis, our findings suggest that macroscopic decidual lesions are more frequent than initially believed during pregnancy.…”