Abstract
BackgroundOvarian endometriomas are classified as benign ovarian lesions. During pregnancy endometriomas may undergo major morphological changes which are referred to as ‘decidualisation’. Decidualised ovarian endometrioma may resemble malignant ovarian tumours on ultrasound examination. The aim was to study variations in the morphology and size of ovarian endometriomas diagnosed on ultrasound during pregnancy.MethodsWe searched our database to identify pregnant women who were diagnosed with ovarian endometriomas on ultrasound in order to study the effect of pregnancy on their morphological characteristics. In women who underwent serial scans during pregnancy we examined the changes in the size of endometriomas with advancing gestation.ResultsTwenty four patients with a total of 34 endometriomas were included in the analysis. All women were managed expectantly during pregnancy. On the first ultrasound scan 29/34 (85.3%, 95% CI 73.4 - 97.2) endometriomas appeared unilocular with fine internal echoes (‘ground glass’ contents) and they were poorly vascularised on Doppler examination. 1/34 (2.9% 95% CI 0.0 - 8.5) endometrioma was multilocular, with regular margins, ‘ground glass’ contents and it was also poorly vascularised. 4/34 (11.8%, 95% CI 1.0 - 22.6) had sonographic features suggestive of decidualisation such as thick and irregular inner wall, papillary projections and highly vascular on Doppler examination. The endometriomas showed a tendency to decrease in size during pregnancy.ConclusionsPregnancy has a major effect on the size and morphological appearances of ovarian endometriomas. Rapid regression of decidualised endometriomas is a helpful feature which could be used to confirm their benign nature.
Highlights
Ovarian endometriomas are classified as benign ovarian lesions
We identified 24 pregnant women who were diagnosed with ovarian endometriomas in pregnancies between January 2009 and May 2013
There were 34 cysts in total: 15/24 (62.5%, 95% Confidence intervals (CI) 43.1 - 81.9) women had single unilateral endometrioma, 5/24 (20.8%, 95% CI 4.6 - 37.0) had multiple unilateral cysts and 4/24 (16.7%, 95% CI 1.8 - 31.6) had bilateral endometriomas. 9/24 (37.5%, 95% CI 18.1 - 56.9) women were surgically diagnosed with endometriosis prior to their pregnancies
Summary
Ovarian endometriomas are classified as benign ovarian lesions. During pregnancy endometriomas may undergo major morphological changes which are referred to as ‘decidualisation’. Decidualised ovarian endometrioma may resemble malignant ovarian tumours on ultrasound examination. Despite the variability in their appearances endometriomas are relatively easy to classify correctly on ultrasound examination with the reported sensitivity and specificity being as high as 92% and 97% respectively [4,5,7,8,9]. Hormonal changes associated with the pregnancy may cause alterations in the sonographic appearances of endometriomas which are referred to as decidualisation. Decidualisation is the process of endometrial change caused by high progesterone levels which increases glandular epithelial secretion, accumulation of glycogen and stromal vascularity. These changes create conditions which facilitate implantation and development of early gestation. Decidualised endometriomas may develop extensive intraluminal papillary projections with increased blood flow which are similar to malignant ovarian tumours [11,12,13]
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