Vaginal Endometriosis: An Enigma for Clinicians

Abstract

Endometriosis is the presence of ectopic endometrial tissue that responds to hormonal stimulation. Although it occurs most often in pelvis, several unusual sites have been reported like skin, umbilicus, vagina, etc. The pivotal case here is a 19-year-old lady who presented with a vaginal polypoidal growth mimicking carcinoma vagina. She gave a history of irregular vaginal bleeding since 3 years and something protruding through the vagina periodically before and during menstrual period. It was accompanied by moderate-to-severe dysmenorrhea and persistent pain in right iliac fossa. MRI was suggestive of B/L Adnexal masses with focal soft tissue lesion involving Right posterolateral fornix. On EUA, patient had a 3 × 4 cm polypoidal tongue-like vascular growth arising from right posterolateral fornix which was totally excised using diathermy. The histological exam of the tissue showed features of endometriosis. The patient was managed by monthly i/m injections of Depot preparation of GnRH analogs for 6 months. The patient now is absolutely symptom free. EUA and excision followed by proper medical management allayed the anxiety of patient and her parents.