Polypoid endometriosis of the ovary and müllerianosis of pelvic lymph nodes mimicking an ovarian carcinoma with lymph node metastasis

Abstract

Polypoid endometriosis is a distinctive variant of endometriosis with histological features simulating those of endometrial polyps. Müllerianosis is characterized by the presence of lesions at any site containing admixtures of endosalpingiosis, endometriosis, and endocervicosis. Here, we report a rare case of polypoid endometriosis of the ovary with müllerianosis of the pelvic lymph nodes in a 44-year-old woman without a past history of pelvic surgery. Magnetic resonance imaging revealed an ovarian tumor containing papillary nodules up to 3.0 cm in diameter and left pelvic lymph node enlargement. Nodules in ovarian tumor showed heterogeneous high intensity on T2weighted image and high intensity on diffusion-weighted image and were mildly enhanced by gadolinium contrast material. Enlarged lymph node was markedly enhanced by gadolinium. We considered polypoid endometriosis in the differential diagnosis according to the results of the magnetic resonance imaging, and polypoid endometriosis was included in intraoperative consultation, however, ovarian carcinoma with lymph node metastasis could not be denied. According to histological examination, the final diagnosis was determined as polypoid endometriosis with glandular hyperplasia of the left ovary and müllerianosis in the obturator lymph nodes. To the best of our knowledge, this is the first report of polypoid endometriosis and müllerianosis of the pelvic lymph node.

Fertility preservation of polypoid endometriosis: Case series and literature review

“…One of the 15 cases had a history of subtotal hysterectomy, and 14 required fertility preservation (Table 1). Among the 14 cases who were requiring fertility preservation, three underwent hysterectomy, 2,9,17 one had bilateral salpingo‐oophorectomy, 13 and 11 underwent fertility‐preserving treatments, such as tumor resection. However, none reported the delivery of a baby after the treatment of PE involving the internal genitalia.…”

“…Although malignant transformation is rare, 6 the presence of a solid mass within the cysts on morphological examination suggests a malignant tumor. [7][8][9][10][11][12][13][14][15] Recurrence after excision is frequent due to the difficulty of complete local resection. 10,16 Owing to the morphological features, a differential preoperative diagnosis is usually a malignant tumor.…”

“…Patients' backgrounds have included endometriosis, tamoxifen administration, and unopposed estrogen associated with hormone replacement therapy, 2 indicating that it is an estrogen‐dependent disease. Although malignant transformation is rare, 6 the presence of a solid mass within the cysts on morphological examination suggests a malignant tumor 7–15 . Recurrence after excision is frequent due to the difficulty of complete local resection 10,16 .…”

Clinical study on 7 cases of polypoid endometriosis. PEM: a mimic of malignancy, the symptoms of adenomyosis, endometrial polyps and infertility can assist in diagnosis

“…(Table 4). [11] 43 post vaginal fornix / prolonged menstruation 3 MRI CEA 2017 Zhuang, L [12] 62 ureteric tamoxifen gross hematuria 1.5⋅1.0 CA 125 37.6 2017 Han, K [13] 58 Colonic / uterine bleeding 13x7x4 / 2017 Iida, Y [14] 44 ovary / müllerianosis of the pelvic lymph node 3.0 MRI 2017 Jaegle, WT [15] 62 endocervical, uterine serosal surface tamoxifen pelvic mass 1. individual in ureter, fallopian tubes, greater omentum and retroperitoneal region [3][4][5][6]7,9] . As shown in Table 1, ovarian PEM accounted for 4 of the 7 cases in this group, followed by uterine serosal and cervical PEM.…”

“…Parker [2] believed that PEM was common in elderly women, and 60% of the 24 PEM patients they observed were older than 50 years old (23-78 years old), with multifocal lesions, and most of the cases had a history of EMs. In addition, 13 international cases reported in the past 5 years, aged 20-62 (51.14±3.78) years old (as Table 4) [10][11][12][13][14][15][16][17][18][19][20][21] , were summarized. Gunawardane DN reported a 50-year-old female had a hysterectomy and bilateral salpingo-oophorectomy for adenomyosis, uterine leiomyomas, ovarian and cervical endometriosis.…”