Endometrioma

Changed by Dr Henry Knipe on 22 Sep 08:16

Updates to Article Attributes

Body was changed:

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:- typically typically, lesions appear hyper-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

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:

  • -<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 &gt; 40 years after several years of latency, with endometriomas larger than 9cm <sup>4-5</sup>.  Malignant transformation is uncommon in masses &lt; 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 &gt; 40 years after several years of latency, with endometriomas larger than 9cm <sup>4-5</sup>.  Malignant transformation is uncommon in masses &lt; 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

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2: endometrioma, fibroid and ovarian cyst
    Drag here to reorder.
  • Case 3
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  • Case 6
    Drag here to reorder.
  • Case 7: chocolate cyst in right adnexa
    Drag here to reorder.
  •  Case 8
    Drag here to reorder.
  • Case 9: T1 C+ fat sat
    Drag here to reorder.
  • Case 10: MRI T1
    Drag here to reorder.
  • Case 11
    Drag here to reorder.
  • Case 12
    Drag here to reorder.
  • Case 13
    Drag here to reorder.
  • Case 14
    Drag here to reorder.
  • Case 15: bilateral ovarian
    Drag here to reorder.
  • Case 16
    Drag here to reorder.
  • Case 17
    Drag here to reorder.
  • Case 18
    Drag here to reorder.
  • Case 19: MRI signs
    Drag here to reorder.
  • Case 20
    Drag here to reorder.
  • Case 21: shading sign
    Drag here to reorder.
  • Case 22: ruptured endometrioma
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.