Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey (Dr. Tolga)
Department of Obstetrics and Gynecology, Sisli Research and Education Hospital, University of Health Sciences, Istanbul, Turkey (Dr. Karatas)

ABSTRACT

Introduction: Ovarian endometrioma, the clinical phenotype of endometriosis, is found in 17% to 44% of patients with endometriosis and is related to the severe form of the condition. The observation of endometrioma and dermoid tumor in the same ovary can be evaluated as atypical endometrioma or ovarian cancer in ultrasound findings.

Case Description: The objective of this report is to present two cases in which an endometrioma and a dermoid tumor are present in the same ovary and to review the subject together with the results of 10 previously reported cases in the literature.

Discussion: The ultrasound findings in atypical endometriomas and endometriomas that mimic ovarian tumors are combinations of papillary projections, hyperechoic irregular walls, a distinct solid mass, and calcifications. Magnetic resonance imaging is the second option for patients who are ultrasonographically identified as having an indeter- minate adnexal mass, and it can provide additional information in distinguishing between the two pathologies within the same ovary. Due to suspected malignancy, unnecessary tests and gynecologic oncology consultations are recommended in cases of atypical endometrioma. This may lead to an increase in the frequency of unnecessary midline laparotomy.

Key Words: Endometrioma; Dermoid cyst; Ultrasonography.

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Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, Canada (Drs. Zang, Bedaiwy). Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA (Drs. Abdelhafez, Bedaiwy, Liu).

ABSTRACT

Introduction: Müllerian anomalies can be challenging to diagnose. We describe a patient with uterus didelphys and cervical atresia who presented with a symptomatic pelvic mass that was incompletely diagnosed as an endometrioma. Consequently, it was inadequately treated at the time of laparotomy, necessitating a laparoscopic hemihysterectomy for definitive management.

Case Description: A 17-year-old nulligravida presented with abdominal pain and pelvic pressure. Computed tomographic imaging showed an 18-cm pelvic mass and left renal agenesis. The patient underwent an exploratory laparotomy with resection of a large endometrioma and left salpingo-oophorectomy. During the operation, an enlarged left uterine horn was observed and was kept intact. She made an uneventful recovery, but returned 6 months later with pelvic pain and pressure. Ultrasonography and hysterosalpingogram diagnosed uterus didelphys with left cervical atresia causing an obstructed hemiuterus. Laparoscopic hemihysterectomy with extensive adhesiolysis was performed, and the patient’s symptoms resolved.

Discussion: Endometrioma is rare in adolescents, and its presence should raise suspicion of a mu¨llerian anomaly. Laparoscopic management, while safe and feasible, is more challenging in the setting of dense adhesions from a prior laparotomy. Preoperative magnetic resonance imaging is recommended in adolescents who present with chronic pelvic pain and a symptomatic pelvic mass, to rule out a congenital anomaly and avoid a needless second surgery.

Key Words: Cervical atresia, Endometrioma, Hemihysterectomy, Müllerian anomaly, Uterus didelphys.

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