Three Separate Cases of Polypoid Endometriosis Coincided with Abscess, Angioleiomyoma or Stromal Sarcoma

Abstract

Background: Polypoid endometriosis is rare and differs from classic endometriosis. It has been primarily documented in case reports and often misdiagnosed as malignancy. The aim of this study is to report three separate cases of polypoid endometriosis coincided with multiple abscess, angioleiomyoma or stromal sarcoma, respectively.

Case presentation: The first case was 36 years old and presented with six months of dysmenorrhea and menstrual fever. Two cervical masses, one located in vaginal and one in pelvic, were detected by ultrasound. After a total hysterectomy, she was diagnosed with cervical polypoid endometriosis with multiple abscess. The second case aged 36-years too and had menstrual bleeding prolonged to 10-15 days for four months. Ultrasound showed a 6cm mass like leiomyomas but with rich vascularity, while MRI tested signal intensity similar to that of endometrium. A diagnosis of polypoid endometriosis coincided with angioleiomyoma was made after surgery. The third patient was 40 and experienced lower abdominal pain for eight months. The ultrasound and MRI tested multiple solid-cystic masses in the left ovary and pelvic. The subsequent pathology revealed extensive stromal nodules in various areas such as bilateral ovaries, posterior uterine wall, intestinal tract and left ureter, indicating the diagnosis of low malignant potential stromal sarcoma.

Conclusion: Polypoid endometriosis coincided with multiple abscess, angioleiomyoma or stromal sarcoma are rather rare and require aggressive surgical treatment.

Keywords: abscess; angioleiomyoma; case series; polypoid endometriosis; stromal nodules.

Figure 1

Cervical posterior isthmus penetrating pyogenic PEM. (A and B) Gross appearance of cervix purulent secretion and a fresh granuloma in the posterior apex, (C) MRI imaging showing the pelvic mass and a posterior granuloma, and (D) microphotograph showing endometrial glands, stroma and abscess.

Figure 2

PEM coexisting with angioleiomyomas. (A) Ultrasound image showing leiomyomas exhibiting rich vascularity, (B) MRI image showing its signal intensity similar to that of the endometrium, (C and D) microphotograph showing ectopic endometrial and angioleiomyomas.

Figure 3

PEM with endometrial stromal nodules and disseminated growth. (A) FS-T2WI shows multiple left ovarian and pelvic solid cystic masses, while solid components are moderately hyperintense; (B) solid components are markedly hyperintense on DWI (high b-value), (C) ectopic endometrial and stromal nodules, and (D) endometriosis and abundant stroma.