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Ovarian endometriosis. Intraoperative photograph (a) showing an endometrioma or “chocolate cyst” (arrow) associated with the ovary (*). Ultrasound (b) of an endometrioma demonstrates homogenous low-level echoes with a fluid–fluid level; corresponding sagittal T2WI MR (c) image eight weeks later reveals low T2 signal or T2 shading, with fluid–fluid level (arrow). Axial T1WI MR with fat saturation (d) shows bilateral endometriomas with T1 hyperintensity and “kissing ovary” morphology
Source publication
Endometriosis is a common benign condition affecting women. The disease has a broad spectrum of presentations from incidental lesions in asymptomatic women to causing significant and debilitating morbidity in others. Ectopic endometrial glands are located in predictable locations throughout the pelvis, including implantation on the ovaries and in t...
Citations
... It has also been suggested that there are interactions between the immune system, hormones, genes, local and stem cells [9]. Extragenital endometriosis can affect the gastrointestinal system (rectum, sigmoid colon, liver), urogenital system (bladder, ureters), respiratory system and nervous system [12,13]. Others locations may concern the umbilicus, breast and others [14]. ...
... It has also been suggested that there are interactions between the immune system, hormones, genes, local and stem cells [9]. Extragenital endometriosis can affect the gastrointestinal system (rectum, sigmoid colon, liver), urogenital system (bladder, ureters), respiratory system and nervous system [12,13]. Others locations may concern the umbilicus, breast and others [14]. ...
Introduction:
Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation.
Objective:
The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique.
Patients and methods:
We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020.
Results:
During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03).
Conclusions:
We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.
... Approximately 95% of typical endometriosis cases occur within the pelvis [2]. After the gastrointestinal tract, the second most common location of extrapelvic endometriosis is the urinary system [3][4][5]. Since many cases are asymptomatic, the prevalence of urinary endometriosis, which is estimated to be approximately 0.3-12% of all cases of endometriosis [3,6], remains unclear [4]. ...
... Moreover, The urethra was involved in 2% of women with urinary tract endometriosis [4]. Urethral endometriosis is usually noted and described as a direct continuation of bladder endometriosis [5]. In one case report, an endometriosis lesion was present in a urethral diverticulum [5]. ...
... Urethral endometriosis is usually noted and described as a direct continuation of bladder endometriosis [5]. In one case report, an endometriosis lesion was present in a urethral diverticulum [5]. ...
Paraurethral endometriosis is an extremely rare condition. To the best of our knowledge, only seven cases with details on variable risk factors have been reported in the English literature. Herein, we present the case of a third nulliparous patient described in the literature at the time of diagnosis. A 30-year-old woman presented with mild urinary symptoms. A well-defined 2.3 cm paraurethral cystic lesion was found on clinical examination, and MRI findings were suggestive of hemorrhagic content, with no evidence of pelvic endometriosis. Complete surgical excision was performed, and the patient's symptoms improved. The patient experienced no recurrence for 10 months postoperatively. The histopathological findings were suggestive of endometriosis. These findings might indicate that embryonic remnants are possible causes of the pathogenesis of paraurethral endometriosis.
... Endometriosis can be found in 10%-15% of women of childbearing age, but it can be as high as 90% in those with chronic pelvic pain [1] . Endometriosis occurs when endometrial gland ✩ Funding statement: No funding sources were utilized. ...
... (J.W. Revels). and stromal tissue are found outside the uterus [1] . The exact mechanism regarding the origin of the tissue presence outside the uterus has not been determined [2] . ...
... Some theories include the metastatic spread of endometrial tissue, metaplastic change of tissue, and a combination of the metastatic spread with metaplastic change [2] . Endometriosis can be categorized into ovarian endometriomas, superficial peritoneal implants, and deep infiltrating endometriosis [1] . The clinical presenta- includes chronic pelvic pain (may be severe), dyspareunia, dysmenorrhea, infertility, and gross hematuria [2] . ...
Endometriosis affects 10%-15% of women of childbearing age, but the incidence can be as high as 90% in those with chronic pelvic pain. Endometriosis is categorized into ovarian endometriomas, superficial peritoneal implants, and deep infiltrating endometriosis. In this case report a 40-year-old woman gravida 1, para 1 with a history of hysterectomy in Mexico presented with chronic abdominal pain and severe hematuria. Magnetic resonance imaging revealed an infiltrative pelvic mass involving the bladder concerning for a neoplasm that demonstrated subtle hyperintense components on T1-weighted images. The diagnosis of infiltrative endometriosis was established following cystoscopy and tissue sampling. This case highlights the importance of considering endometriosis in the differential for patients with pelvic masses, and recognizing potential features that could suggest the diagnosis.
A diverse spectrum of pathologically distinct, nonneoplastic, proliferative conditions of the kidneys and urinary tract demonstrate a expansile growth pattern similar to that of neoplasms. The renal pseudotumors include myriad causes of infections as well as rare noninfectious causes such as sarcoidosis, amyloidosis, and immunoglobulin G4-related disease (IgG4-RD). Rare entities such as cystitis cystica, endometriosis, nephrogenic adenoma, and pseudosarcomatous myofibroblastic proliferation and distinct types of prostatitis comprise tumefactive nontumorous disorders that affect specific segments of the urinary tract. The pseudotumors of the kidneys and urinary tract demonstrate characteristic histopathologic and epidemiologic features, as well as protean clinical manifestations, natural history, and imaging findings. Many patients present with genitourinary tract-specific symptoms or systemic disease. Some cases may be incidentally discovered at imaging. Some entities such as perinephric myxoid pseudotumors, IgG4-RD, fibroepithelial polyp, and nephrogenic adenoma display specific anatomic localization and disease distribution. Imaging features of multisystem disorders such as tuberculosis, sarcoidosis, and IgG4-RD provide supportive evidence that may allow precise diagnosis. Fungal pyelonephritis, xanthogranulomatous pyelonephritis, IgG4-RD, actinomycosis, and endometriosis show markedly low signal intensity on T2-weighted MR images. Although some pseudotumors exhibit characteristic imaging findings that permit correct diagnosis, laboratory correlation and histopathologic confirmation are required for definitive characterization in most cases. A high index of suspicion is a prerequisite for diagnosis. Accurate diagnosis is critical for instituting optimal management while preventing use of inappropriate therapies or interventions. Surveillance CT and MRI are frequently used for monitoring the response of pseudotumors to therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
