A Case report: Polypoid endometriosis mimicking malignant tumor

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  • 悪性腫瘍に類似したpolypoid endometriosisの2症例

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Polypoid endometriosis is a rare type of endometriosis that forms polypoid or tumor-like masses and sometimes clinically mimics a malignant neoplasm. A 53-year-old woman (gravida 2, para 2) underwent surgery for bilateral ovarian tumors and was diagnosed with an endometriotic cyst at 40 years of age and received endocrine therapy (low dose estrogen-progestin, GnRH agonist and dienogest) for endometriosis until 51 years of age. Endocrine therapy was discontinued 2 years later, and she presented to our emergency department with severe lower abdominal pain. Imaging revealed a pelvic mass, hemorrhagic ascites, and disseminated peritoneal lesions. We suspected metastatic ovarian cancer and performed resection of the mass together with a peritoneal lesion biopsy; histopathological evaluation of the resected specimen confirmed thecoma and endometriosis. A 47-year-old premenopausal woman (gravida 4, para 2), who received low dose estrogen-progestin therapy for severe dysmenorrhea was referred to our hospital with uterine enlargement and elevated serum cancer antigen 125 levels. Magnetic resonance imaging revealed a right ovarian tumor and a mass in the uterine fundus. We performed surgery and observed marked disseminated peritoneal lesions intraoperatively. However, she was diagnosed with endometriosis based on histopathological evaluation of resected specimens. Rapid intraoperative diagnosis is important to avoid unnecessary invasive surgery. In addition, because polypoid endometriosis can relapse in some cases, long-term follow-up may be needed．

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