Polypoid endometriosis mimicking invasive cancer in an obese, postmenopausal tamoxifen user

Polypoid endometriosis-An exceptional subtype of endometriosis mimicking an aggressive pelvic cancer

Polypoid endometriosis is a rare manifestation of endometriosis, which may mimic pelvic cancer. This subtype commonly encountered in post-menopausal women may be wrongly mistaken for a neoplasm on clinical, radiological, perioperative or pathologic assessments leading to inadequate treatment.

Fertility preservation of polypoid endometriosis: Case series and literature review

Polypoid endometriosis (PE) is a rare distinctive variant of endometriosis with morphological features resembling malignant tumors. Although a surgical procedure is usually performed for the treatment and diagnosis of PE, fertility preservation is usually desired in cases of reproductive age. However, there have been no reports of fertility-preserving treatments resulting in live births. In this study, we report three cases of PE that were diagnosed preoperatively or intraoperatively, leading to fertility preservation. Intraoperative pathological diagnosis, hysteroscopy, and hormone therapy before treatment were useful for preoperative diagnosis in the three cases. Two of the three patients got pregnant and the pregnancy progressed to a live birth. We also performed a literature review to identify the clinical characteristics indicative of the preoperative diagnosis of PE.

Polypoid Endometriosis of the Rectum and Vagina in an Adolescent

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.

Polypoid endometriosis - A rare entity of endometriosis mimicking ovarian cancer

OBJECTIVE

To report a rare case of polypoid endometriosis with initial impression of ovarian cancer and review the published literature about this disease.

CASE REPORT

A 23-year-old female presented with sudden onset of acute lower abdominal pain. Image studies revealed an irregular shaped, heterogeneous mass at the cul-de-sac, but without ascites or enlargement of pelvic or paraaortic lymph nodes. Blood tests showed an elevated CA-125 value (1317 U/ml). Resection of the mass was performed by laparotomy and the frozen section and final pathology both revealed polypoid endometriosis. Post-operative gonadotropin-releasing hormone agonist was given for 6 months followed by oral contraceptives. She remained disease free 3 years after operation.

CONCLUSION

Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. Gynecologists should be aware of this rare form of a commonly benign disease to avoid excessive resection in younger patients of childbearing age.

Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports

Background

To review women with symptomatic and clinically progressive endometriosis after menopause in the absence of estrogen intake or excessive systemic endogenous production.

Design

Seven case reports and a systematic review of the literature from 1995 till February 2018.

Results

Only 7 case reports from the authors and 29 cases from the literature described women with either cystic ovarian or deep endometriosis. Severity, symptoms, and localization are highly variable. No case report describes symptomatic superficial typical lesions. In 22 of 36 women (61%), symptoms started more than 10 years after menopause.

Conclusions

Symptomatic and clinically progressive endometriosis after menopause in the absence of increased systemic estrogen concentrations or exogenous estrogen intake starts more than 10 years after menopause in the majority of women. This observation suggests that a genetic and/or epigenetic incident caused estrogen-independent progression, increased sensitivity to estrogens or increased local production of estrogens. This observation is important for understanding the pathophysiology of endometriosis, for the management of postmenopausal endometriosis, and for individualization of medical therapy of endometriosis since estrogen-independent endometriosis growth probably also occurs before menopause.