A rare case of giant endometrioma-with ultrasound features mimicking malignancy

A rare case of giant endometrioma-with ultrasound features mimicking malignancy DOI: https://doi.org/10.18203/2320-1770.ijrcog20242839Keywords: Diagnostic dilemma, Giant endometrioma, Risk of malignancy index, IOTA simple rulesAbstract Ovarian endometriomas are common in women of reproductive age but rarely exceed 6 cm in diameter. Ovarian endometrioma exceeding 10 cm in dimension are referred as giant endometrioma. They are rare and pose a major diagnostic dilemma to the clinicians. We present a rare case of ovarian endometrioma of 18.7 cm in largest diameter, with internal septations, with a solid component, with low grade neovascularization on ultrasonography having RMI I score of 294 suggesting risk of malignancy, and IOTA simple rules suggesting the mass as inconclusive in nature, and the diagnosis of a benign mass was made on frozen section and confirmed as endometrioma on postoperative histopathologic examination. The challenges in making diagnosis of a huge ovarian endometrioma are highlighted and various literature on giant ovarian endometrioma are reviewed. Metrics References Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Euro J Radio. 2023;158:110610. Clement PB. Diseases of the peritoneum. InBlaustein’s pathology of the female genital tract. New York: Springer New York.1994;2:647-703. Fedele L, Bianchi S, Bocciolone L, Di Nola Gi, Parazzini F. Pain symptoms associated with endometriosis. Obste Gynecol. 1992;79(5):767-9. Reuter KL, Davidoff A, Cooney JV, Hunter RE. An unusually large endometrioma simulating an ovarian malignancy. Am J Roent. 1988;151(4):834-5. Mishra TS, Singh S, Jena SK, Mishra P, Mishra L. Giant endometrioma of the ovary: a case report. J Endo Pelvic Pain Dis. 2016;8(2):71-4. Yaşar L, Süha Sönmez A, Galip Zebitay A, Neslihan G, Yazıcıoğlu HF, Mehmetoğlu G. Huge ovarian endometrioma-a case report. Gynecol Surg. 2010;7(4):365-7. Carnahan M, Fedor J, Agarwal A, Gupta S. Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management. Expert Review of Obstetrics and Gynecology. 2013;8(1):29-55. Van HC, Van CB, Guerriero S, Savelli L, Paladini D, Lissoni AA, et al. Endometriomas: Their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35:730-40. Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Int J Obst Gynaecol. 1990;97(10):922-9. Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;14:341. Froehlich JM, Metens T, Chilla B, Hauser N, Hohl MK, Kubik-Huch RA. MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery. Eur J Radiol. 2012;81(3):598-602. Stern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecolog Pathol. 2001;20(2):133-9. Machado LF, Sánchez FML, Cascales P, Torroba A, Orozco R, Silva SY, et al. Prevalence of endometriosis in epithelial ovarian cancer. Analysis of the associated clinical features and study on molecular mechanisms involved in the possible causality. Eur J Gynaecol Oncol. 2015;36(1):21-4. Salgado IMA, Pereira AMG, Lopes RGC, Davi SD, Pinheiro DJPC. Persistence and recurrence of ovarian endometrioma. J Reprod Med Gynecol Obstet 2020;5:38.