Endometrioma
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An endometriomaEndometriomas, (alsoalso known as a chocolate cystcysts or endeometriotic cystcysts) is, are a localised form of endometriosis (usually and are usually within the ovary).
Epidemiology
It affects women of reproductive age.
Pathology
ItEndometriomas contains dark degenerated blood products following repeated cyclical haemorrhage. The cysts may be up to 20 cm in size although they are usually smaller (2-5cm).
Location
Typical locations include
- ovaries:
~ 75~75% - anterior
/ posterior/posterior cul-de-sac:~ 70~70% - posterior broad ligament:
~ 50~50% - uterosacral ligaments:
~ 35~35% - uterus:
~ 10~10 % - colon:
~ 5~5%
Radiographic features
Plain film
Not usually helpful in diagnosis. ~ 10~10% of endometriomas can calcify.
Ultrasound
In the typical situation there is acoustic enhancement with diffuse homogenous low-level internal echoes as a result of the haemorrhagic debris. This appearance occurs in 95% of cases and is considered the classic finding on ultrasound examination. Features of multi-locularity and hyper-echoic wall foci may be present. Anechoic cysts may occur, but they are rare.
MRI
Signal characteristics vary according to the age of any complicating haemorrhage 6.:
-
T1:
- typicallytypically, lesions appearhyper-intensehyperintense while acute haemorrhage occasionally appears hypo-intense -
T2:
-- typically
hypo-intensehypointense owing to the presence of deoxyhaemoglobin and methaemoglobin - old haemorrhage occasionally appears
hyper-intense.hyperintense
- typically
A shading sign3 may be seen and is very suggestive of an endometrioma.
Treatment and prognosis
Although endometrioma is aendometriomas are usually a benign entity, there is an approximately 1~1% rate of malignant transformation 4. It is seen mostly in women > 40 years after several years of latency, with endometriomas larger than 9cm 4-5. Malignant transformation is uncommon in masses < 6cm.
If not surgically excised, follow-up should be at least yearly 4. GnRH agonists may be used for medical management.
Differential diagnosis
General imaging differential considerations include:
- haemorrhagic ovarian cyst
-
ovarian dermoid cyst
- will - cystic neoplasm
- tubo-ovarian abscess
-<p>An <strong>endometrioma</strong> (also known as a <strong>chocolate cyst</strong> or <strong>endeometriotic cyst</strong>) is a localised form of <a href="/articles/endometriosis">endometriosis</a> (usually within the ovary).</p><h4>Epidemiology</h4><p>It affects women of reproductive age.</p><h4>Pathology</h4><p>It contains dark degenerated blood products following repeated cyclical haemorrhage. The cysts may be up to 20 cm in size although they are usually smaller (2-5cm)</p><h5>Location</h5><p>Typical locations include</p><ul>-<li>ovaries : ~ 75%</li>-<li>anterior / posterior cul-de-sac : ~ 70 % </li>-<li>posterior broad ligament : ~ 50% </li>-<li>uterosacral ligaments : ~ 35%</li>-<li>uterus : ~ 10 %</li>-<li>colon : ~ 5% </li>-</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>Not usually helpful in diagnosis. ~ 10% of endometriomas can calcify.</p><h5>Ultrasound</h5><p>In the typical situation there is acoustic enhancement with diffuse homogenous low-level internal echoes as a result of the haemorrhagic debris. This appearance occurs in 95% of cases and is considered the classic finding on ultrasound examination. Features of multi-locularity and hyper-echoic wall foci may be present. Anechoic cysts may occur, but they are rare.</p><h5>MRI</h5><p>Signal characteristics vary according to the age of any complicating haemorrhage <sup>6</sup>.</p><ul>- +<p><strong>Endometriomas</strong>,<strong> </strong>also known as a <strong>chocolate cysts</strong> or <strong>endeometriotic cysts</strong>, are a localised form of <a href="/articles/endometriosis">endometriosis</a> and are usually within the <a title="Ovary" href="/articles/ovaries">ovary</a>.</p><h4>Epidemiology</h4><p>It affects women of reproductive age.</p><h4>Pathology</h4><p>Endometriomas contains dark degenerated blood products following repeated cyclical haemorrhage. The cysts may be up to 20 cm in size although they are usually smaller (2-5cm).</p><h5>Location</h5><p>Typical locations include</p><ul>
- +<li>ovaries: ~75%</li>
- +<li>anterior/posterior cul-de-sac: ~70% </li>
- +<li>posterior broad ligament: ~50% </li>
- +<li>uterosacral ligaments: ~35%</li>
- +<li>uterus: ~10 %</li>
- +<li>colon: ~5% </li>
- +</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>Not usually helpful in diagnosis. ~10% of endometriomas can calcify.</p><h5>Ultrasound</h5><p>In the typical situation there is acoustic enhancement with diffuse homogenous low-level internal echoes as a result of the haemorrhagic debris. This appearance occurs in 95% of cases and is considered the classic finding on ultrasound examination. Features of multi-locularity and hyper-echoic wall foci may be present. Anechoic cysts may occur, but they are rare.</p><h5>MRI</h5><p>Signal characteristics vary according to the age of any complicating haemorrhage <sup>6</sup>:</p><ul>
-<strong>T1 </strong>- typically, lesions appear hyper-intense while acute haemorrhage occasionally appears hypo-intense</li>- +<strong>T1:</strong> typically, lesions appear hyperintense while acute haemorrhage occasionally appears hypo-intense</li>
-<strong>T2</strong> -<ul>-<li>typically hypo-intense owing to the presence of deoxyhaemoglobin and methaemoglobin</li>-<li>old haemorrhage occasionally appears hyper-intense.</li>- +<strong>T2:</strong><ul>
- +<li>typically hypointense owing to the presence of deoxyhaemoglobin and methaemoglobin</li>
- +<li>old haemorrhage occasionally appears hyperintense</li>
-</ul><p>A <a href="/articles/shading-sign">shading sign</a><sup>3</sup> may be seen and is very suggestive of an endometrioma.</p><h4>Treatment and prognosis</h4><p>Although endometrioma is a usually a benign entity, there is an approximately 1% rate of malignant transformation <sup>4</sup>. It is seen mostly in women > 40 years after several years of latency, with endometriomas larger than 9cm <sup>4-5</sup>. Malignant transformation is uncommon in masses < 6cm.</p><p>If not surgically excised, follow-up should be at least yearly <sup>4</sup>. GnRH agonists may be used for medical management.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>- +</ul><p>A <a href="/articles/shading-sign">shading sign</a> <sup>3</sup> may be seen and is very suggestive of an endometrioma.</p><h4>Treatment and prognosis</h4><p>Although endometriomas are usually a benign entity, there is an ~1% rate of malignant transformation <sup>4</sup>. It is seen mostly in women > 40 years after several years of latency, with endometriomas larger than 9cm <sup>4-5</sup>. Malignant transformation is uncommon in masses < 6cm.</p><p>If not surgically excised, follow-up should be at least yearly <sup>4</sup>. GnRH agonists may be used for medical management.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
-<a href="/articles/mature-cystic-ovarian-teratoma">ovarian dermoid cyst</a><a href="/articles/ovarian_dermoid"> </a>- will show fat suppression on fat suppressed sequences on MRI</li>- +<a href="/articles/mature-cystic-ovarian-teratoma">ovarian dermoid cyst</a>: will show fat suppression on fat suppressed sequences on MRI</li>
Images Changes:
Image 2 MRI (T2) ( update )
Caption
was changed:
Case 2: endometrioma +, fibroid +and ovarian cyst
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