Giant endometrioma in an asymptomatic patient

Abstract

Endometriosis is a chronic inflammatory gynecologic disorder characterized by the presence of endometrial-like tissue, including endometrial glands and stroma, outside of the uterine cavity. It is a prevalent condition worldwide, affecting approximately 10% of reproductive-age women and up to 50% of infertile women. Endometriosis manifests in three ways: superficial peritoneal endometriosis, deep infiltrative endometriosis, and ovarian endometriomas, with the possibility of coexistence among them. The disease presents with a range of symptoms, including chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Additionally, patients may experience nongynecological symptoms such as dyschezia, dysuria, hematuria, flank pain, and fatigue, among others. The ovaries are the most affected site in endometriosis, typically with cysts measuring less than 6 cm in diameter. Therefore, even in the presence of a large ovarian cyst or in asymptomatic patients, the consideration of an endometrial cyst should not be overlooked.

Keywords: Endometriosis; Giant endometrioma; Magnetic resonance imaging.

Fig. 1

(A) Abdominal computed tomography: demonstrated a solid right adnexal region mass (white arrow), and a cystic mass originated from the left adnexal region (black arrow). (B and C) Pelvic ultrasound: demonstrated a cystic mass (black arrows) in the left adnexal region. It was unilocular and homogenous, with low-level internal echoes, a well-defined wall, and no solid areas or internal blood flow. In the right adnexal region, a mass with a solid appearance and similar echogenicity to the myometrium (white arrow) was identified.

Fig. 2

(A–D) Magnetic resonance imaging demonstrated a right adnexal mass with characteristics consistent with a leiomyoma (A - white arrow) originating from the uterus, as indicated by the bridging vessel sign (A - red arrow). Right ovary was also identified (blue arrow). A cystic mass (A – black arrow) with its origin identified as the left ovary, indicated by the claw sign (B - green arrow). In the retrocervical region, an ill-defined infiltrative tissue was observed, hypointense on T2-weighted images (B - orange arrow), with some areas of high signal intensity on T1-weighted images (C - orange arrow). This finding was consistent with deep endometriosis. The signal on T1-weighted images (C and D- black arrows) showed homogeneous high-signal intensity without solid components, indicating an endometrioma.