Polypoid Endometriosis of the Rectum and Vagina in an Adolescent

Abstract

Background: Polypoid endometriosis (PEM) is a rare type of endometriosis, frequently mimicking a malignant tumor. We report on a patient with PEM over a 10-year span who had symptoms at age 16. Case: A 20-year-old woman presented with massive vaginal hemorrhage and spontaneous abortion, having symptoms of dysmenorrhea, anal distending pain, and vaginal bleeding since adolescence. Imaging showed multiple polypoid neoplasms of the rectum and vagina connecting to the huge mass in a cul de sac. After exploration and excision, the pathology revealed PEM.

Ultrasound features of polypoid endometriosis: a case report and a short review of Literature

“…2 At imaging studies, this characteristics correspond to irregular and heterogeneous infiltrative masses which can show central hemorrhage areas and solid components, with a reduced or negative sliding between the lesion and organs such as the uterus or the rectum. [4][5][6][7] At MRI scan, PEM can present as heterogeneous masses with high signal intensity in T2-weighted images, accompanied by a peripheral T2-hypointense rim corresponding to fibrous tissue [7][8][9] ; other features can include a lobulated nodular profile; central irregular T2-hyperintense areas with "shadow sign," corresponding to hemorrhage foci; mild enhancement resembling that of uterine eutopic endometrium; and lack of diffusion restriction, implying absence of high cellularity. [5][6][7][8][9] Ascites, peritoneal implants and lymphadenopathy are usually absent.…”

“…[4][5][6][7] At MRI scan, PEM can present as heterogeneous masses with high signal intensity in T2-weighted images, accompanied by a peripheral T2-hypointense rim corresponding to fibrous tissue [7][8][9] ; other features can include a lobulated nodular profile; central irregular T2-hyperintense areas with "shadow sign," corresponding to hemorrhage foci; mild enhancement resembling that of uterine eutopic endometrium; and lack of diffusion restriction, implying absence of high cellularity. [5][6][7][8][9] Ascites, peritoneal implants and lymphadenopathy are usually absent. [7][8][9] At TVUS examination, PEM has been described as voluminous heterogeneous masses, with irregular echogenicity and sometimes the presence of cystic areas 4,5 ; its imaging features can imply a difficult differential diagnosis with ovarian malignancy, although sometimes normally appearing uterus and adnexa can be observed.…”

“…[5][6][7][8][9] Ascites, peritoneal implants and lymphadenopathy are usually absent. [7][8][9] At TVUS examination, PEM has been described as voluminous heterogeneous masses, with irregular echogenicity and sometimes the presence of cystic areas 4,5 ; its imaging features can imply a difficult differential diagnosis with ovarian malignancy, although sometimes normally appearing uterus and adnexa can be observed. 4 In a significant proportion of cases, PEM arises from ovarian endometriomas, 3,8 presenting as cysts with solid components, as in this case which could be described as a multilocular-solid lesion according to IOTA terminology.…”

“…[7][8][9] On the other hand, few works include a description of sonographic features of PEM at transvaginal ultrasound (TVUS) evaluation, reporting limited findings such as the presence of heterogenous masses with irregular echogenicity and cystic areas. 4,5,8 Ultrasound evaluation of pelvic masses has been gaining increasing importance during the recent years, due to the availability of shared terminology and criteria meant to assess the mass and estimate its risk of malignancy, as the ones proposed by the International Ovarian Tumor Analysis (IOTA) group [10][11][12][13] ; advantages such as reproducibility, wide accessibility, and fairly good accuracy allowed TVUS to be considered the main diagnostic tool in the approach to adnexal masses. Common descriptors and patterns of presentation have been proposed for several adnexal lesions and related to histologic features.…”

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

“…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.…”