8346 Polypoid Endometriosis: A Distinct Variant

Abstract

<h3>Study Objective</h3> To examine a case study of polypoid endometriosis and perform a literature review. <h3>Design</h3> Case Report. <h3>Setting</h3> Academic institution <h3>Patients or Participants</h3> 1 Patient. <h3>Interventions</h3> Surgical resection. <h3>Measurements and Main Results</h3> A 34-year-old nulliparous woman with complex adnexal masses and severe left hydronephrosis presented for consultation. Menarche occurred at 12 years-old, followed by regular monthly menses lasting 5 days. The patient reported multiple emergency room visits for severe dysmenorrhea and was taking combined hormonal contraceptives with good effect since adolescence. Of note, she had discontinued her contraceptives as she was trying to conceive. Examination revealed a non-obese female with bilateral lower abdominal tenderness to palpation. Initial labs showed elevations in CA125, HE4, and CA19-9. Imaging demonstrated a complex 7cm right adnexal mass with severe left hydronephrosis secondary to enhancing fibrosis in the left hemipelvis. This was suspicious for deep infiltrating endometriosis. The patient underwent robotic bilateral ovarian cystectomy, excision of endometriosis, right salpingectomy, left ureteral reimplantation with psoas hitch, appendectomy, and cystoscopy. Stage IV endometriosis was noted intraoperatively. Intraoperative frozen pathology was benign. Her recovery was overall uncomplicated. Final pathology was consistent with polypoid endometriosis. Follow up imaging revealed recurrence of bilateral complex adnexal masses. <h3>Conclusion</h3> Polypoid endometriosis is an uncommon, distinct variant of endometriosis with histological features suggestive of an endometrial polyp. Unlike usual-type endometriosis, which commonly affects reproductive-aged women, polypoid endometriosis primarily affects older patients with a mean age of 52.5-years-old. Patients with polypoid endometriosis often present with mass effect or vaginal bleeding. It is characterized by a tendency to mimic neoplastic processes clinically, intra-operatively, and on gross examination. Polypoid endometriosis also demonstrates a high rate of recurrence after surgical excision, as seen in our case study. Given the ability of polypoid endometriosis to mimic malignancy, intraoperative frozen pathology may prevent a more extensive surgery and excessive resection in patients of childbearing age.