A Masquerade Ball: Polypoid Endometriosis Mimicking Peritoneal Carcinomatosis

Abstract

Study Objective To present the identifying characteristics of polypoid endometriosis as well as techniques for safe and effective resection of the disease. Design Stepwise demonstration of characteristics and techniques with narrated video footage. Setting Polypoid endometriosis is a rare variant of endometriosis first described in 1980. It microscopically resembles an endometrial polyp and is significantly associated with unopposed estrogen. It can precede premalignant and malignant conditions and has been reported in pre- and post-menopausal women. In this video, we review the visual characteristics of polypoid endometriosis as well as principles for safe and efficient resection of the disease. Patients or Participants A 60-year-old female with multiple abdominopelvic soft tissue nodules on CT scan concerning for peritoneal carcinomatosis. CT-guided biopsy demonstrated endometriosis, and the patient underwent laparoscopic cytoreductive surgery. Interventions When viewed laparoscopically, polypoid endometriosis appears as a lesion with irregular borders surrounded by scarring and fibrosis. Neovascularization appears commonly in these implants. The key principles for safe and effective resection of polypoid endometriosis include: Defining the borders of the lesion via palpation and thinning of the surrounding tissue Thoughtful instrument choice to minimize instrument switching during surgery Meticulous hemostasis to preserve visualization and prevent tissue staining Performance of ureterolysis, if necessary, to mobilize this structure away from the intended area of dissection Maintenance of a margin around the lesion to ensure complete resection Measurements and Main Results The patient recovered well without any postoperative complications. Conclusion Polypoid endometriosis should be a diagnostic consideration when imaging suggests peritoneal carcinomatosis.