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Olinger K, Maheshwari E, Shenoy-Bhangle AS, Adejolu M, McGettigan M, Mathew H, Lee KS, Nicola R. Mimics of cancer in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 48:1752-1773. [PMID: 36577923 DOI: 10.1007/s00261-022-03783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
Pregnancy is a remarkable time of pronounced growth and development of the fetus. Benign pathologies outside of the uterus, including those containing hormonally responsive tissue which undergo physiologic changes and other incidentally identified lesions, may mimic malignancy on clinical evaluation and imaging. A detailed history and physical exam, ultrasound and non-contrast magnetic resonance imaging features and comparison with prior imaging if available may help to narrow the list of potential differential diagnoses. Follow-up imaging in the postpartum period is often vital to confirm benignity and, in some cases, sampling to confirm the diagnosis is necessary. This review will cover the clinical, pathological and multimodality imaging features of numerous potential mimickers of cancer in the setting of pregnancy organized by organ systems. The goal is to better equip abdominal radiologists to accurately identify benign disease and help guide further imaging or follow-up recommendations to avoid unnecessarily aggressive intervention and improve patient care.
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Affiliation(s)
- Kristen Olinger
- Division of Abdominal Radiology, Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Building, Chapel Hill, NC, 27599, USA.
| | - Ekta Maheshwari
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15143, USA
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02214, USA
| | - Margaret Adejolu
- Department of Radiology, The Royal Marsden Hospital, London, England, UK
| | | | | | - Karen S Lee
- Division of Abdominal Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Refky Nicola
- Division of Abdominal Imaging, Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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2
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Younis JS. Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook. Biomolecules 2022; 12:1721. [PMID: 36421735 PMCID: PMC9688199 DOI: 10.3390/biom12111721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 08/16/2023] Open
Abstract
Endometriosis is a chronic, universal, and prevalent disease estimated to affect up to 1:10 women of reproductive age. Endometriosis-associated ovarian cancer (EAOC) developing at reproductive age is challenging and of concern for women and practitioners alike. This outlook review focuses on the occurrence of EAOC, especially in infertile women or those planning for a future pregnancy, from the perspective of a reproductive endocrinologist, based on recent evidence. Contemporary pathogenesis, genetic profiles, evidence of causality, clinical diagnosis, prognosis, and up-to-date management are discussed. EAOC seems to be merely associated with endometrioma and includes clear-cell and endometrioid ovarian carcinoma. Although endometrioma is frequently found in women of reproductive age (up to 1:18 of women), EAOC appears to be a rare occurrence. These women are of more advanced reproductive age, nulliparous, and hyperestrogenic, with a large-sized unilateral endometrioma (>9 cm) containing solid components and papillary projections. Each case suspected to have EAOC has specific characteristics, and a multidisciplinary discussion and appropriate patient counseling should be conducted to reach an optimal therapeutic plan. Since most of these cases are diagnosed at an early stage with a favorable prognosis, fertility-sparing surgery may be feasible. The pros and cons of fertility preservation techniques should be discussed.
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Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel; ; Tel.: +972-505286981; Fax: +972-46737478
- Azrieli Faculty of Medicine in Galilee, Bar-Ilan University, Safed 1311502, Israel
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3
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Maslenko M, De-Porto A, Stanleigh J, Sharvit M, Maklakovski M, Barel O. Peritoneal endometriosis presenting as fever of unknown origin, ascites and peritoneal miliary spread: A rare case report and review of the literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221116156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Endometriosis associated with ascites is a rare form of endometriosis. We identified only 81 publications describing women with this pathology. The purpose of this review was to search the existing literature and to understand the clinical presentations and possible treatment options. A 28-year-old patient was admitted due to a fever of unknown origin and lower abdominal pain. Her CT scan was normal with some non-specific lymph-node enlargement up to 1.6 cm and the presence of ascites. Diagnostic laparoscopy revealed a large amount of hemorrhagic ascites. The entire peritoneal surface was covered with milliary nodules. The pathology report revealed peritoneal stromal endometriosis. Endometriosis is an important differential diagnosis in women with ascites and treatment of this form of endometriosis is a real dilemma.
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Affiliation(s)
- Maria Maslenko
- Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
| | - Atara De-Porto
- Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
| | - Jonathan Stanleigh
- Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
| | - Merav Sharvit
- Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
| | - Marina Maklakovski
- Pathological Institute, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
| | - Oshri Barel
- Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel. Affiliated with the Faculty of Health Sciences Ben Gurion University, Israel
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4
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Endometriosis associated with pleural effusion and ascites. Am J Med Sci 2022; 364:499-501. [PMID: 35588893 DOI: 10.1016/j.amjms.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 01/25/2023]
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5
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Pandraklakis A, Prodromidou A, Haidopoulos D, Paspala A, Oikonomou MD, Machairiotis N, Rodolakis A, Thomakos N. Clinicopathological Characteristics and Outcomes of Patients With Endometriosis-Related Hemorrhagic Ascites: An Updated Systematic Review of the Literature. Cureus 2022; 14:e26222. [PMID: 35911338 PMCID: PMC9313015 DOI: 10.7759/cureus.26222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
The presence of ascites is a common clinical presentation in gynecologic oncology patients. Hemorrhagic ascites (HA) due to endometriosis is a rare presentation that can be easily misdiagnosed as ovarian malignancies. The present study aims to update the currently available knowledge on the characteristics of patients presenting with HA due to endometriosis. A systematic search was conducted for articles published from January 2000 to July 2020 using the Medline, Scopus, and Google Scholar databases along with the references of the full-text articles retrieved. Papers describing cases of women over 18 years with or without previous history of endometriosis were assessed. Only cases with histologically proven hemorrhagic ascites of endometriosis origin were included. Twenty-nine studies (27 case reports and two case series) comprising 32 patients were evaluated. The mean patients’ age was 32 years, while six of the patients had a previous history of endometriosis. The mean amount of drained ascitic fluid was 4,200 mL, whereas three patients underwent thoracentesis due to pleural effusions. The treatment options included not only medical but also surgical therapies. Fertility preservation was achieved in 27 patients, while two of them achieved pregnancy with in vitro fertilization (IVF) techniques. Endometriosis-related hemorrhagic ascites is a relatively rare expression of the disease. Endometriosis-related hemorrhagic ascites should be considered in the differential diagnosis (DD) of women with ascites and clinical suspicion of endometriosis. The available literature is limited to case reports and case series and thus indicates further research in the field to decode the pathophysiology of the disease and decide on the optimal treatment.
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6
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Bahall V, De Barry L, Harry SS, Bobb M. Gross Ascites Secondary to Endometriosis: A Rare Presentation in Pre-Menopausal Women. Cureus 2021; 13:e17048. [PMID: 34522526 PMCID: PMC8427934 DOI: 10.7759/cureus.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/05/2022] Open
Abstract
Ascites caused by endometriosis is an unusual phenomenon with approximately 60 cases described since it was first reported in 1954. Moreover, such a case has rarely been reported in the Caribbean literature. Ascites is frequently treated with surgical options that do not preserve fertility. This is due to the association of ascites with gynaecological malignancies in women with elevated serum cancer antigen (CA-125). We describe three cases of severe endometriosis associated with massive ascites, successfully treated with hormonal therapy while preserving fertility.
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Affiliation(s)
- Vishal Bahall
- Obstetrics and Gynaecology, The University of the West Indies, St Augustine, TTO.,Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Lance De Barry
- Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Suman S Harry
- Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Maria Bobb
- Obstetrics and Gynaecology, Sangre Grande Hospital, Sangre Grande, TTO
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7
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Chan-Tiopianco M, Chao WT, Ching PR, Jiang LY, Wang PH, Chen YJ. Clinical Presentation and Management of Endometriosis-Related Hemorrhagic Ascites: A Case Report and Systematic Review of the Literature. Cureus 2021; 13:e15828. [PMID: 34306891 PMCID: PMC8297110 DOI: 10.7759/cureus.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
This study aims to analyze the patient profile and presentation of endometriosis-related hemorrhagic ascites and review its management to raise awareness among gynecologists and improve treatment strategies. We present a case report and engage in a systematic review involving human cases of histologically proven endometriosis with hemorrhagic ascites. Keywords were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, and Ovid Discovery databases from inception until December 2018. Studies that did not include a description of ascites or histopathologic results confirming endometriosis or those that involved patients with other conditions that may contribute to ascites were excluded. The review yielded 73 articles describing 84 premenopausal women with histologically proven endometriosis-related hemorrhagic ascites. Of note, 83% (65/78) of the patients were nulliparous and 69.35% (43/62) were of African descent. The most common chief complaint was abdominal enlargement (58.33%, 49/84) but a host of other symptoms were also reported. Pleural effusion was reported in 32.14% (27/84), and elevated CA-125 was seen in 74.42% (32/43). The majority (64.29%, 54/84) of the patients underwent laparotomy, and an increasing trend of minimally invasive surgical approaches (p<0.001) and fertility-sparing techniques (p<0.001) was observed. The mean ascites volume was 4228.27 mL (SD: 2625.66). Moderate to severe endometriosis was seen in 97.44% (76/78) of cases. The majority of the patients who received medical treatment were given gonadotropin-releasing hormone (GnRH) agonists (63.79%, 37/58). The rate of recurrence after termination or suppression of ovarian function was 8.33% (7/84), and there was a mortality rate of 1.19% (1/84). Diagnosis of endometriosis-related hemorrhagic ascites may be challenging because it mimics several disease entities that cause ascites, thereby warranting a heightened clinical suspicion. Minimally invasive techniques are usually employed to establish a histologic diagnosis. The prevention of recurrence involves the recognition of endometriosis-related hemorrhagic ascites as a manifestation of severe endometriosis, which should prompt therapies directed at suppressing ovarian function. Since affected women are of childbearing age, ovary-preserving surgeries are generally preferred. The rate of recurrence is low after appropriate surgical and medical interventions.
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Affiliation(s)
- Mareesol Chan-Tiopianco
- Division of Obstetrics and Gynecology, San Lazaro Hospital, Manila, PHL
- Department of Obstetrics and Gynecology, ManilaMed - Medical Center Manila, Manila, PHL
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, TWN
| | - Patrick R Ching
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, TWN
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, TWN
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, TWN
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, TWN
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, TWN
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, TWN
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8
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Wang P, Meng Z, Li Y, Xu Z. Endometriosis-Related Pleural Effusion: A Case Report and a PRISMA-Compliant Systematic Review. Front Med (Lausanne) 2021; 8:631048. [PMID: 33859990 PMCID: PMC8042286 DOI: 10.3389/fmed.2021.631048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown. Objectives: We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease. Methods: A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed. Results: A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone (P = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) (P = 0.040). Conclusions: High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.
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Affiliation(s)
- Ping Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yakun Li
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Baoding No. 1 Hospital, Baoding, China
| | - Zuojun Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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9
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Han X, Zhang ST. Novel triple therapy for hemorrhagic ascites caused by endometriosis: A case report. World J Clin Cases 2020; 8:6206-6212. [PMID: 33344624 PMCID: PMC7723716 DOI: 10.12998/wjcc.v8.i23.6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Massive hemorrhagic ascites caused by endometriosis is exceedingly rare, and the treatment strategy remains controversial. Here, we report a case of endometriosis with massive hemorrhagic ascites treated with a novel triple therapy including conservative surgery, gonadotropin-releasing hormone agonist, and then dienogest.
CASE SUMMARY A 28-year-old nulliparous patient was admitted to Shengjing Hospital of China Medical University, and exploratory laparoscopy was performed. A total of 9500 mL of brown ascites was aspirated from the pelvic cavity, the bilateral ovaries strongly adhered to the posterior of the uterus and were fixed to the pelvic floor, and endometriotic cysts were not observed in either ovary. The pelvic and abdominal peritonea were covered with patchy red, white, and brown endometriotic lesions and defects. Partial surgical resection of endometriotic lesions on the peritoneum was performed while we simultaneously collected multiple peritoneal biopsies. The final pathological diagnosis was endometriosis coupled with hemorrhagic necrotic tissue.
CONCLUSION Postoperative injection of gonadotropin-releasing hormone agonist was provided three times, followed by dienogest administration, and we will continue to follow up with this ongoing treatment.
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Affiliation(s)
- Xue Han
- Gynecology Department, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Shi-Tai Zhang
- Gynecology Department, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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10
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Han X, Zhang ST. Novel triple therapy for hemorrhagic ascites caused by endometriosis: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjccc.v8.i23.6198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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11
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Endometriosis-Associated Massive Ascites in an Asian Woman: A Case Report of a Rare Clinical Entity. Case Rep Obstet Gynecol 2020; 2020:8879643. [PMID: 32832176 PMCID: PMC7424375 DOI: 10.1155/2020/8879643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Massive ascites as a presentation of endometriosis is a rare clinical entity that is most commonly seen in black nulliparous females. Herein, we describe a case of a 32-year-old multiparous Thai woman who presented with a two-year history of abdominal distension. Computerized tomography of the abdominopelvic region showed an infiltrative enhancing lesion involving the cul-de-sac and perirectal region with massive loculated ascites, suggesting carcinomatosis peritonei. Abdominal paracentesis was performed to yield fluid samples for evaluation, which revealed no malignant cells, and polymerase chain reaction (PCR) was negative for tuberculosis. The patient underwent exploratory laparotomy which revealed a large amount of serosanguinous ascites, thickened matted bowel loops, and necrotic debris covering the entire surface of the peritoneum and visceral organs. The surgical procedures included drainage of 6.5 liters of ascites, lysis adhesion, biopsy of the peritoneum, and right salpingo-oophorectomy. Histologic examination revealed benign endometrial glands with stroma at the peritoneum tissue and broad ligament. Other causes of ascites were excluded. The ascites responded to drainage and hormonal suppression. A final diagnosis of endometriosis was made based on these findings. Endometriosis should therefore be considered in differential diagnosis in women of childbearing age who present with ascites.
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12
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Pang L, Shi H, Wang T, Zhu L, Lang J, Fan Q, Liu H, Yu X, Cao Y, Xiao Y. Endometriosis on the surface of the uterus mimicking a malignant tumor: A case report with literature review. Medicine (Baltimore) 2019; 98:e15741. [PMID: 31124955 PMCID: PMC6571359 DOI: 10.1097/md.0000000000015741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The purpose of this case report was to raise awareness regarding endometriosis on the surface of the uterus mimicking malignant tumor and thus manage it accurately. PATIENT CONCERNS A 40-year-old Asian woman with a 2-year history of lower abdomen pain was admitted to our department with elevated serum cancer antigen (CA) 125 level, weight loss, and pelvic mass from 20 days previously. Magnetic resonance imaging revealed a high volume of effusion in the pelvic cavity, an irregular occupying lesion on the surface of the fundus of the uterus, and multiple nodules. DIAGNOSES Postoperative pathology confirmed the diagnosis of endometriosis. INTERVENTIONS Diagnostic laparoscopy revealed large crunchy tissue and soft nodules on the surface of the posterior wall of the uterus and approximately 2000 mL of bloody ascites. The result of the frozen-section analysis of the tissue on the surface of the uterus indicated endometriosis. The surgical procedure was converted to laparotomy due to bleeding after biopsy. OUTCOMES The patient's recovery was uneventful. Three months after the operation, the patient had a good general state without periodic pain, and the CA125 level returned to normal. LESSONS A large mass occurring in the pelvic cavity could be indicative of endometriosis, especially if accompanied by a history of period pain. Preoperative positron emission tomography may increase the accuracy of the diagnosis.
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Affiliation(s)
| | | | - Tao Wang
- Department of Obstetrics and Gynecology
| | - Lan Zhu
- Department of Obstetrics and Gynecology
| | | | | | | | - Xin Yu
- Department of Obstetrics and Gynecology
| | - Yang Cao
- Department of Obstetrics and Gynecology
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
A 27-year-old woman with swelling left leg, groin pain, and increased serum CA125 level underwent FDG PET/CT to evaluate a pelvic mass revealed by an MRI performed from an outside hospital. A large hypermetabolic solid mass in the left pelvic wall and several lymph nodes with elevated FDG activity were noted, which indicated malignancy. However, histopathological examination demonstrated endometriosis.
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14
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Recurrent massive ascites due to mossy endometriosis. Fertil Steril 2016; 106:e14. [PMID: 27542707 DOI: 10.1016/j.fertnstert.2016.07.1119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/04/2016] [Accepted: 07/27/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To report the medical and surgical management of a rare case of recurrent moss-like endometriosis and associated hemorrhagic ascites. DESIGN Video description of the case, demonstration of the surgical technique, discussion of the histology, and review of endometriosis-associated ascites. SETTING Tertiary referral center. PATIENT(S) A 26-year-old nulliparous woman of Nigerian heritage with recurrent hemorrhagic ascites due to endometriosis. Three years previously she underwent an exploratory laparotomy for similar symptoms, and 7 L of hemorrhagic ascites were evacuated from her abdomen. Friable lesions covering the peritoneum of the uterus, bladder, and pouch of Douglas were biopsied and consistent with endometriosis. After her initial surgery, the patient was hormonally suppressed with goserelin for 3 months and oral medroxyprogesterone for 1 year. She then stopped the medications to attempt pregnancy but was unsuccessful. She used clomiphene for 3 months, and the ascites reaccumulated. The patient was started on depot leuprolide and oral norethindrone, but the ascites persisted. INTERVENTION(S) The patient underwent small-diameter laparoscopy using a multipuncture technique, evacuation of 7.8 L of hemorrhagic ascites, enterolysis, appendectomy, chromopertubation, and treatment of the endometriosis. MAIN OUTCOME MEASURE(S) Diffuse olive-green "mossy" endometriosis lesions blanketed the pelvic and abdominal peritoneum. The endometriosis was surgically resected with a combination of peritoneal stripping, excision with carbon dioxide laser, and ablation with neutral argon plasma. Examination of the ascites showed scattered hemosiderin-laden macrophages in a background of red blood cells. Histology of the olive-green mossy lesions revealed dense sheets of hemosiderin-laden macrophages and rare foci of endometriosis. Surgical reports in deidentified patients are exempted from Institutional Review Board approval. The patient gave consent to use photography and images for the video article. RESULT(S) No postoperative hormone suppression was given to the patient because she desired pregnancy. At 6 months after her second surgery, the patient had not achieved pregnancy, but the ascites had not reaccumulated. She was referred for further infertility care. CONCLUSION(S) This rare form of mossy endometriosis often mimics ovarian cancer, pelvic tuberculosis, and other gynecologic conditions, but when identified, the endometriosis can be treated and symptoms can subside with drainage of the ascites, thorough ablation of the diffuse, superficial lesions, and restoration of anatomy.
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15
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Cosma S, Ceccaroni M, Benedetto C. A pseudoneoplastic finding of deep endometriosis: laparoscopic triple segmental bowel resection. Wideochir Inne Tech Maloinwazyjne 2014; 9:463-7. [PMID: 25337175 PMCID: PMC4198630 DOI: 10.5114/wiitm.2014.41617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/05/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022] Open
Abstract
Bowel endometriosis affects 3-37% of patients with endometriosis, involving more frequently the rectum and the rectosigmoid junction. Severe endometriosis with bowel involvement is often refractory to standard medical therapy. For these reasons, surgery for bowel treatment is frequently needed. We report the case of a 36-year-old woman with deep endometriosis of the pelvis, triple segmental bowel involvement (recto-sigma, ileum-cecum, transverse colon) and massive endometriotic ascites with secondary Glisson's capsule inflammation, refractory to medical therapy. A laparoscopic triple segmental bowel resection and complete fertility sparing excision of pelvic endometriotic lesions was performed. At 48 months of follow-up, the woman was asymptomatic, with no evidence of recurrence of disease or ascites. Laparoscopic segmental bowel resection, including multiple section, is feasible in selected symptomatic patients with consequent improved quality of life, morbidity rates similar to those achieved by laparotomy and with a less detrimental effect on fertility.
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Affiliation(s)
- Stefano Cosma
- Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Marcello Ceccaroni
- Department of Gynecology and Obstetrics, Gynecologic Oncology Division, International School of Surgical Anatomy, European Gynecology Endoscopy School, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Chiara Benedetto
- Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Turin, Italy
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16
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Bhat RA, Teo M, Bhat AK. Endometriosis after surgical menopause mimicking pelvic malignancy: surgeons' predicament. Oman Med J 2014; 29:226-31. [PMID: 24936277 DOI: 10.5001/omj.2014.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/12/2014] [Indexed: 12/23/2022] Open
Abstract
Prevalence of persistent endometriosis in women after menopause without any hormonal replacement therapy is very rare. This is a case of a woman with previous history of total hysterectomy and bilateral salpingo-oophorectomy for endometriosis who presented with hemoperitoneum, vaginal bleeding, pelvic mass, and pulmonary thromboembolism mimicking as rectovaginal septum carcinoma. This is the first case report with a unique mode of presentation wherein the patient presented with hemoperitoneum requiring emergency embolization of the vessel to stabilize the patient. She underwent en bloc resection of the tumor with high anterior resection of the rectum. Histopathology confirmed endometriosis.
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Affiliation(s)
- Rani A Bhat
- Consultant Gynaecological Oncologist HCG Oncology No. 8, P Kalinga Rao Road Sampangi Ramnagar Bangalore - 560027. India
| | - Melissa Teo
- Senior Consultant, Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Akhil Krishnanand Bhat
- Senior Consultant-General Surgery, St. Philomena's Hospital, No. 4 Cambell Road, Viveknagar, Bangalore-560047, India
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Endometriosis Presenting with Massive Ascites and Pleural Effusion: A Case Report. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2013. [DOI: 10.5301/je.5000162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Endometriosis is a complex disease commonly encountered by gynecologists. We report the case of an otherwise healthy young nullipara who presented with massive ascites, pleural effusion and shortness of breath and was subsequently diagnosed with endometriosis. This case demonstrates that, with a careful history, physical examination and appropriate tests, patients may be effectively treated with minimally invasive procedures and gonadotropin-releasing hormone (GnRH) agonists, and avoid major emergency surgery.
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A Case Presentation: Decidualized Endometrioma Mimicking Ovarian Cancer during Pregnancy. Case Rep Obstet Gynecol 2013; 2013:728291. [PMID: 23662226 PMCID: PMC3639707 DOI: 10.1155/2013/728291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
During pregnancy, masses that are larger than 5 cm and appearing in the Doppler ultrasonography as having increased blood flow, echoes of heterogeneous density, and containing solid components are suspicious for malignancy; however, differential diagnosis of decidualized endometriomas should also be considered. The patient was an 8 weeks pregnant primigravida. The ultrasonographic evaluation showed a cystic mass of size 65 × 57 mm in the left ovary that was well circumscribed, heterogeneous, with highly dense internal echo, and containing a solid component of size 8 × 14 mm. In the 12th week, the ultrasonographic examination revealed an increase in the size of the mass and increased arterial blood flow in the mass. The patient underwent surgery. It was observed that both ovaries were adherent in the Douglas pouch and that the left ovary contained an endometrioma of size 8cm. While the capsule was being peeled, lesions of soft density, with irregular surfaces, and with adhesion in the Douglas pouch were observed. The results of the frozen section revealed decidualized endometrioma and decidual structures. Even in pregnant women when adnexal masses are encountered and the ultrasonography, Doppler, MRI, and CA 125 level analysis still do not favor endometriosis, decidualized endometrioma should be considered in the differential diagnosis.
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Terada T. Clear cell adenocarcinoma of the ovary arising in atypical endometriosis: a report of eight cases. Arch Gynecol Obstet 2011; 285:229-33. [DOI: 10.1007/s00404-011-1929-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
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A systematic review: endometriosis presenting with ascites. Arch Gynecol Obstet 2010; 283:513-8. [PMID: 20821226 DOI: 10.1007/s00404-010-1664-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. METHODS To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. RESULTS Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. CONCLUSION Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.
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21
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Endometriosis-associated infertility: surgery and IVF, a comprehensive therapeutic approach. Reprod Biomed Online 2010; 21:179-85. [DOI: 10.1016/j.rbmo.2010.04.026] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 11/26/2009] [Accepted: 03/23/2010] [Indexed: 11/22/2022]
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Ignacio MM, Joseph N, Hélder F, Mamourou K, Arnaud W. Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol 2010; 149:117-8. [DOI: 10.1016/j.ejogrb.2009.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 08/11/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
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23
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Endometriosis Mimicking Ovarian Cancer in the Setting of Acquired Immune Deficiency Syndrome. Obstet Gynecol 2009; 114:425-426. [DOI: 10.1097/aog.0b013e318198a429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Ussia A, Betsas G, Corona R, De Cicco C, Koninckx PR. Pathophysiology of cyclic hemorrhagic ascites and endometriosis. J Minim Invasive Gynecol 2009; 15:677-81. [PMID: 18971129 DOI: 10.1016/j.jmig.2008.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 08/20/2008] [Indexed: 12/20/2022]
Abstract
Massive hemorrhagic ascites (4470 mL, range 1-10 L) in women with endometriosis is a rare condition occurring predominantly in black women. Of the 43 case reports published, 42 are compatible with the hypothesis that the hemorrhagic ascites is predominantly a consequence of excessive ovarian transudation similar to a Meigs syndrome. Indeed, bilateral ovariectomy cures the condition without recurrences, whereas after unilateral ovariectomy or cystectomy recurrence rate is more than 50%; during ovarian suppression by luteinizing hormone-releasing hormone agonist ascites disappears, but reappears after treatment. Superficial pelvic endometriosis also contributes to the ascites because after superficial endometriosis destruction the recurrence rate is only 4 in 14. Based on these data, it is suggested, to scrutinize the ovaries for tumors given the analogy with Meigs syndrome. In women desiring fertility, conservative treatment with destruction of endometriosis only can be attempted given the cure rate of some 20%. It is unknown what the effect of ovulation induction would be.
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Affiliation(s)
- Anastasia Ussia
- Department of Obstetrics and Gynecology, Villa Giose, Crotone, Italy
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Differential Diagnosis of Gynecologic Organ-Related Diseases in Women Presenting with Ascites. Taiwan J Obstet Gynecol 2008; 47:384-90. [DOI: 10.1016/s1028-4559(09)60003-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sait KH. Massive ascites as a presentation in a young woman with endometriosis: a case report. Fertil Steril 2008; 90:2015.e17-9. [PMID: 18778818 DOI: 10.1016/j.fertnstert.2008.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/21/2008] [Accepted: 07/09/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To report a case of endometriosis associated with massive ascites and an elevated CA-125 level. DESIGN Case report. SETTING Tertiary care center. PATIENT(S) A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer. INTERVENTION(S) Ultrasonography, laparotomy, and bilateral ovarian cystectomy and reconstruction. Endometriosis was diagnosed postoperatively on the basis of histopathology. The patient received 6 months of treatment with a GnRH analogue. MAIN OUTCOME MEASURE(S) Ultrasound examination 6 months after surgery to evaluate for ascites or recurrent ovarian cysts. RESULT(S) Frozen sections obtained at laparotomy and ovarian cystectomy ruled out a malignancy. The final histologic report was compatible with a diagnosis of endometriosis. After 6 months of treatment with the GnRH analogue, the patient experienced a progressive reduction of the ascitic fluid and full remission after 2 years. CONCLUSION(S) Endometriosis associated with massive bloody ascites is an unusual occurrence. This report draws attention to this condition as a complication of endometriosis. For this reason, endometriosis should be included in the differential diagnosis of reproductive-age women presenting with an apparent ovarian malignancy.
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Affiliation(s)
- Khalid H Sait
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
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Abstract
BACKGROUND Endometriosis is rarely a cause of recurrent hemorrhagic ascites. This report draws attention to this uncommon condition, which could present a diagnostic dilemma. CASE A young African-American woman who had experienced recurrent hemorrhagic ascites for more than 2 years underwent laparotomy and was found to have extensive pelvic endometriosis. After a hysterectomy and bilateral salpingo-oophorectomy, her ascites resolved. CONCLUSION Endometriosis should be considered in the differential diagnosis of recurrent hemorrhagic ascites in premenopausal women. The diagnosis always requires operative assessment and histologic confirmation.
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Affiliation(s)
- Meena Palayekar
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey 08901, USA.
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