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BMC Women's Health
Published in: BMC Women's Health 1/2014

Open Access 01-12-2014 | Research article

Natural history of ovarian endometrioma in pregnancy

Authors: Katie Pateman, Francesca Moro, Dimitrios Mavrelos, Xulin Foo, Wee-Liak Hoo, Davor Jurkovic

Published in: BMC Women's Health | Issue 1/2014

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Abstract

Background

Ovarian endometriomas are classified as benign ovarian lesions. During pregnancy endometriomas may undergo major morphological changes which are referred to as ‘decidualisation’. Decidualised ovarian endometrioma may resemble malignant ovarian tumours on ultrasound examination. The aim was to study variations in the morphology and size of ovarian endometriomas diagnosed on ultrasound during pregnancy.

Methods

We searched our database to identify pregnant women who were diagnosed with ovarian endometriomas on ultrasound in order to study the effect of pregnancy on their morphological characteristics. In women who underwent serial scans during pregnancy we examined the changes in the size of endometriomas with advancing gestation.

Results

Twenty four patients with a total of 34 endometriomas were included in the analysis. All women were managed expectantly during pregnancy. On the first ultrasound scan 29/34 (85.3%, 95% CI 73.4 - 97.2) endometriomas appeared unilocular with fine internal echoes (‘ground glass’ contents) and they were poorly vascularised on Doppler examination. 1/34 (2.9% 95% CI 0.0 - 8.5) endometrioma was multilocular, with regular margins, ‘ground glass’ contents and it was also poorly vascularised. 4/34 (11.8%, 95% CI 1.0 - 22.6) had sonographic features suggestive of decidualisation such as thick and irregular inner wall, papillary projections and highly vascular on Doppler examination. The endometriomas showed a tendency to decrease in size during pregnancy.

Conclusions

Pregnancy has a major effect on the size and morphological appearances of ovarian endometriomas. Rapid regression of decidualised endometriomas is a helpful feature which could be used to confirm their benign nature.
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Literature
1.
Hill LM, Connors-Beatty DJ, Nowak A, Tush B: The role of ultrasonography in the detection and management of adnexal masses during the second and third trimesters of pregnancy. Am J Obstet Gynecol. 1998, 179: 703-10.1016/S0002-9378(98)70068-7.CrossRefPubMed
2.
Yazbek J, Salim R, Woelfer B, Aslam N, Lee CT, Jurkovic D: The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol. 2007, 132: 154-158. 10.1016/j.ejogrb.2006.07.013.CrossRefPubMed
3.
Condous G, Khalid A, Okaro E, Bourne T: Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004, 24: 62-66. 10.1002/uog.1083.CrossRefPubMed
4.
Timmerman D, Schwarzler P, Collins WP, Claerhout F, Coenen M, Amant F, Vergote I, Bourne TH: Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Ostet Gynecol. 1999, 13: 11-16. 10.1046/j.1469-0705.1999.13010011.x.CrossRef
5.
Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D: Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010, 35: 730-740.CrossRefPubMed
6.
Asch E, Levine D: Variations in appearance of endometriomas. J Ultrasound Med. 2007, 26: 993-1002.PubMed
7.
Valentin L: Pattern recognition of pelvic masses by gray-scale ultrasound imaging: the contribution of Doppler ultrasound. Ultrasound Obstet Gynecol. 1999, 14: 338-47. 10.1046/j.1469-0705.1999.14050338.x.CrossRefPubMed
8.
Jermy K, Luise C, Bourne T: The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol. 2001, 17: 140-4. 10.1046/j.1469-0705.2001.00330.x.CrossRefPubMed
9.
Milad MP: Cohen L Preoperative ultrasound assessment of adnexal masses in premenopausal women. Int J Gynaecol Obstet. 1999, 66 (2): 137-41. 10.1016/S0020-7292(99)00063-6.CrossRefPubMed
10.
Miyakoshi K, Tanaka M, Gabionza D, Takamatsu K, Miyazaki T, Yuasa Y, Mukai M, Yoshimura Y: Decidualized ovarian endometriosis mimicking malignancy. Am J Roentgenol. 1998, 171: 1625-1626. 10.2214/ajr.171.6.9843300.CrossRef
11.
Alcázar JL, Mercé LT, Laparte C, Jurado M, López-García G: A new scoring system to differentiate benign from malignant adnexal masses. Am J Obstet Gynecol. 2003, 188: 685-692. 10.1067/mob.2003.176.CrossRefPubMed
12.
Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P: Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001, 76: 929-935. 10.1016/S0015-0282(01)02736-4.CrossRefPubMed
13.
Patel MD, Feldstein VA, Chen DC, Lipson SD, Filly RA: Endometriomas: diagnostic performance of US. Radiology. 1999, 210: 739-745. 10.1148/radiology.210.3.r99fe61739.CrossRefPubMed
14.
Poder L, Coakley FV, Rabban JT, Goldstein RB, Aziz S, Chen LM: Decidualized endometrioma during pregnancy: recognizing an imaging mimic of ovarian malignancy. J Comput Assist Tomogr. 2008, 32: 555-558. 10.1097/RCT.0b013e31814685ca.CrossRefPubMed
15.
Barbieri M, Somigliana E, Oneda S, Ossola MW, Acaia B, Fedele L: Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum Reprod. 2009, 24: 1818-1824. 10.1093/humrep/dep089.CrossRefPubMed
16.
Sayasneh A, Naji O, Abdallah Y, Stalder C, Bourne T: Changes seen in the ultrasound features of a presumed decidualised ovarian endometrioma mimicking malignancy. J Obstet Gynaecol. 2012, 32: 807-11. 10.3109/01443615.2012.707256.CrossRefPubMed
17.
Guerriero S, Ajossa S, Piras S, Parodo G, Melis GB: Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy. Ultrasound Obstet Gynecol. 2005, 26: 304-6. 10.1002/uog.1986.CrossRefPubMed
18.
Ueda Y, Enomoto T, Miyatake T, Fujita M, Yamamoto R, Kanagawa T, Shimizu H, Kimura T: A retrospective analysis of ovarian endometriosis during pregnancy. Fertil Steril. 2010, 94: 78-84. 10.1016/j.fertnstert.2009.02.092.CrossRefPubMed
19.
Mascilini F, Moruzzi C, Giansiracusa C, Guastafierro F, Savelli L, De Meis L, Epstein E, Timor-Tritsch IE, Mailath-Pokorny M, Ercoli A, Exacoustos C, Benacerraf BR, Valentin L, Testa AC: Imaging of gynecological disease: clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy. Ultrasound Obstet Gynecol. 2014, 4: doi:10.1002/uog.13323
20.
Tanaka YO, Shigemitsu S, Nagata M, Shindo M, Okamoto Y, Yoshikawa H, Itai Y: A decidualized endometrial cyst in a pregnant woman: a case observed with a steady-state free precession imaging sequence. Magn Reson Imaging. 2002, 20: 301-304. 10.1016/S0730-725X(02)00499-X.CrossRefPubMed
21.
Iwamoto H, Suzuki M, Watanabe N, Minai M, Hirata S, Hoshi K: Case study of a pregnant woman with decidualized ovarian endometriosis whose preoperative findings suggested malignant transformation. Eur J Gynaecol Oncol. 2006, 27: 301-303.PubMed
22.
Machida S, Matsubara S, Ohwada M, Ogoyama M, Kuwata T, Watanabe T, Izumi A, Suzuki M: Decidualization of ovarian endometriosis during pregnancy mimicking malignancy: report of three cases with a literature review. Gynecol Obstet Invest. 2008, 66: 241-247. 10.1159/000147171.CrossRefPubMed
23.
Takeuchi M, Matsuzaki K, Nishitani H: Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr. 2008, 32: 353-355. 10.1097/RCT.0b013e3181238362.CrossRefPubMed
24.
Yoshida S, Onogi A, Shigetomi H, Tsuji Y, Haruta S, Naruse K, Kanayama S, Noguchi T, Sakata M, Furukawa N, Sado T, Yamada Y, Kitanaka T, Oi H, Kobayashi H: Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor. J Clin Ultrasound. 2008, 36: 512-516. 10.1002/jcu.20496.CrossRefPubMed
25.
Tazegül A, Seçilmiş Kerimoğlu O, Incesu FN, Doğan NU, Yılmaz SA, Celik C: A Case Presentation: Decidualized Endometrioma Mimicking Ovarian Cancer during Pregnancy. Case Rep Obstet Gynecol. 2013, doi:10.1155/2013/728291
26.
Fruscella E, Testa AC, Ferrandina G, Manfredi R, Zannoni GF, Ludovisi M, Malaggese M, Scambia G: Sonographic features of decidualized ovarian endometriosis suspicious for malignancy. Ultrasound Obstet Gynecol. 2004, 24: 578-580. 10.1002/uog.1736.CrossRefPubMed
27.
Meresman GF, Auge L, Baranao RI, Lombardi E, Tesone M, Sueldo C: Oral contraceptives suppress cell proliferation and enhance apoptosis of eutopic endometrial tissue from patients with endometriosis. Fertil Steril. 2002, 77: 1141-1147. 10.1016/S0015-0282(02)03099-6.CrossRefPubMed
28.
Davis L, Kennedy SS, Moore J, Prentice A: Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2007, 18: CD001019-Review
29.
Speroff L, Fritz MA: Clinical Gynecologic Endocrinology and Infertility 8th ed. 2010, Philadelphia, USA: Lippincott Williams & Wilkins
30.
Sammour RN, Leibovitz Z, Shapiro I, Degani S, Levitan Z, Aharoni A, Tal J, Lurie M, Ohel G: Decidualization of ovarian endometriosis during pregnancy mimicking malignancy. J Ultrasound Med. 2005, 24: 1289-94.PubMed
31.
Whitecar MP, Turner S, Higby MK: Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999, 181: 19-24. 10.1016/S0002-9378(99)70429-1.CrossRefPubMed
32.
Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A: Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg. 2012, 99: 1470-8. 10.1002/bjs.8889.CrossRefPubMedPubMedCentral
33.
Harrison P: Psychosocial impact of a cancer diagnosis during pregnancy. Nurs Womens Health. 2013, 17: 437-42. 10.1111/1751-486X.12067.CrossRefPubMed
34.
Holland TK, Cutner A, Saridogan E, Mavrelos D, Pateman K, Jurkovic D: Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study. BMC Women’s Health. 2013, 13: 43-doi:10.1186/1472-6874-13-43CrossRefPubMedPubMedCentral
35.
Aslam N, Ong C, Woelfer B, Nicolaides K, Jurkovic D: Serum CA125 at 11–14 weeks of gestation in women with morphologically normal ovaries. BJOG. 2000, 107: 689-690. 10.1111/j.1471-0528.2000.tb13314.x.CrossRefPubMed
Metadata
Title
Natural history of ovarian endometrioma in pregnancy
Authors
Katie Pateman
Francesca Moro
Dimitrios Mavrelos
Xulin Foo
Wee-Liak Hoo
Davor Jurkovic
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2014
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/1472-6874-14-128

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