Huge ovarian endometrioma that grew after menopause: Case report

Abstract

Endometriomas occur in women of reproductive age and are rare after menopause. A 56-year-old gravida 3 para 2 woman complained of abdominal fullness that had gradually worsened over approximately one year (i.e. 5 years postmenopause). Diagnostic imaging revealed a cystic lesion that extended to just below the diaphragm. An ovarian cystoma of low malignancy was suspected. The preoperative blood test indicated normal estradiol levels at 12.6 pg/mL. She underwent bilateral adnexectomy and total hysterectomy. The appendages on the affected (i.e. right) side weighed approximately 12 kg. An ovarian endometrioma with benign pathology was diagnosed. Postmenopausal endometrioma can occur even in patients with normal postmenopausal estradiol values who are not receiving exogenous hormones. These patients require careful follow-up.

Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports

“…Our review found 29 women (Table 1) with progressively increasing symptoms after menopause in whom endometriosis was diagnosed in the absence of HRT intake or an increased endogenous estrogen production. The symptoms are variable and comprise increasing pain with urinary symptoms [26], an asymptomatic cystic ovarian endometrioma or a cystic ovarian endometrioma with pain [27][28][29][30][31], a small bowel obstruction [32,33], a rectovaginal deep endometriosis [29,34], a sigmoid deep endometriosis [35], even a sigmoid obstruction more than 10 years after menopause [36], a deep endometriosis with progressive hydronefrosis [37], with renal failure [38] and with severe hypertension [39], urinary bleeding with an hydronephrosis and a polypoid intra-ureteral lesion [40], a vaginal endometriotic cyst [41], a lesion mimicking a bowel tumor [42], or an abdominal hemorrhage [43]. Some women were preoperatively suspected to have a cancer either an adenocarcinoma [44] or a disseminated ovarian cancer although during surgery only superficial endometriosis lesions together with bilaterally large endometriomas were found [45].…”

Laparoscopic management of massive recurrent endometrioma with atypical presentation: A case report

“…The biggest endometrioma in literature was reported by Ishikawa et al 4 from Japan in 1997 and it measured 25 × 18 × 12 cm 3 in size, arising from the right ovary, and contained approximately 2500 mL of chocolate-coloured fluid. Another case was reported by Matsushima and Asakura 5 in a postmenopausal lady where the tumour weighed around 12 kg (volume not mentioned) but was managed by laparotomy and not laparoscopically. In our case, the endometrioma was 29 × 28.2 × 15 cm 3 in size with 7 × 6.2 × 4.4 cm 3 solid hemorrhagic component and contained 11,300 mL of chocolate-coloured fluid.…”

Free large sized intra-abdominal endometrioma in a postmenopausal woman: a case report

“…Apparently, the local estrogen production is as important as the circulating estrogen in fueling endometriosis. This is mainly evident in postmenopausal endometriotic patients with normal serum estrogen concentration [ 15 ]. Beside inducing ectopic endometrial cells proliferation, estrogen plays an important role in macrophage recruitment [ 20 ].…”

“…In some cases, endometriosis can be reactivated by the increased estrogen production from peripheral organs or under the influence of the hormone replacement therapy (HRT) [ 14 ]. Rarely, endometriosis can relapse in postmenopausal women with normal estradiol serum levels [ 15 ]. This is mainly attributed to the endometriosis ability of biosynthesizing estrogen via the aromatase activity [ 12 , 16 ].…”