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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Department of Obstetrics and Gynaecology (Drs. L. Eghdami and M. A. Bedaiwy), Division of Reproductive Endocrinology and Infertility (Dr. M. A. Bedaiwy), University of British Columbia, Vancouver, BC, Canada; Department of Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA (Drs. S. Elguero and B. Patel).

ABSTRACT

An interstitial pregnancy is an ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube and embedded within the muscular layer of the uterus. Because of the rich vascular supply of this region, maintaining hemostasis during surgical management of interstitial pregnancies is a recognized challenge. Visualizing the entirety of the gestational sac beneath the uterine serosa can also present a challenge, especially in cases of uncomplicated interstitial ectopic pregnancies. Here we present a case in which intraoperative transvaginal ultrasound was used to assist with a laparoscopic cornual wedge resection in a 24-year-old woman with a confirmed interstitial pregnancy. The use of intraoperative transvaginal ultrasound during the laparoscopy helped accurately delineate the location and extent of invasion of the interstitial pregnancy. It guided the placement of the uterine incision and helped ensure that the entire gestational sac and products of conception had been removed. This case demonstrates that transvaginal ultrasound can be used as an intraoperative tool to enhance surgical safety and minimize patient risk.

Key Words: Ultrasonography, Pregnancy, Ectopic, Laparoscopy.

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