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RSNA Education Exhibits

Malignant Transformation of Pelvic Endometriosis: MR Imaging Findings and Pathologic Correlation

Published Online:Mar 1 2006https://doi.org/10.1148/rg.262055041

Abstract

Malignant transformation is a rare complication of endometriosis. Endometriosis-associated ovarian cancers are seen more often in younger women than are ovarian cancers without endometriosis, and early detection is important to improve the prognosis and preserve fertility. However, normal decidual change of the ectopic endometrium in an endometrioma during pregnancy must be differentiated from malignant transformation. The finding that is most important for a diagnosis of malignant change is the presence of one or more contrast material–enhanced mural nodules within a cystic mass at magnetic resonance (MR) imaging. Dynamic subtraction MR imaging is useful in depicting small contrast-enhanced nodules within the hyperintense endometrioma on T1-weighted images. Intracystic coagulate may mimic a mural nodule; the absence of contrast enhancement is the diagnostic clue to its benignity. Enlargement of the endometrioma and the disappearance of shading within the mass on T2-weighted images are suggestive of malignant transformation.

© RSNA, 2006

References

  • 1 HeapsJM, Nieberg RK, Berek JS. Malignant neoplasms arising in endometriosis. Obstet Gynecol1990;75:1023–1028.
    MedlineGoogle Scholar
  • 2 CornerGW Jr, Hu C, Hertig AT. Ovarian carcinoma arising in endometriosis. Am J Obstet Gynecol1950;59:760–774.
    Google Scholar
  • 3 ScullyRE, Richardson GS, Barlow JF. The development of malignancy in endometriosis. Clin Obstet Gynecol1966;9:384–411.
    MedlineGoogle Scholar
  • 4 McMeekinDS, Burger RA, Manetta A, DiSaia P, Berman ML. Endometrioid adenocarcinoma of the ovary and its relationship to endometriosis. Gynecol Oncol1995;59:81–86.
    MedlineGoogle Scholar
  • 5 SampsonJA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ. Arch Surg1925;10:1–72.
    Google Scholar
  • 6 ScottRB. Malignant changes in endometriosis. Obstet Gynecol1953;2:283–289.
    MedlineGoogle Scholar
  • 7 ScullyRE, Barlow JF. “Mesonephroma” of ovary: tumor of Mullerian nature related to the endometrioid carcinoma. Cancer1967;20:1405–1417.
    MedlineGoogle Scholar
  • 8 TogashiK, Nishimura K, Kimura I, et al. Endometrial cysts: diagnosis with MR imaging. Radiology1991;180:73–78.
    Google Scholar
  • 9 GougoutasCA, Siegelman ES, Hunt J, Outwater EK. Pelvic endometriosis: various manifestations and MR imaging findings. AJR Am J Roentgenol2000;175:353–358.
    MedlineGoogle Scholar
  • 10 SugimuraK, Okizuka H, Imaoka I, et al. Pelvic endometriosis: detection and diagnosis with chemical shift MR imaging. Radiology1993;188:435–438.
    Google Scholar
  • 11 KierR, Smith RC, McCarthy SM. Value of lipid-and water-suppression MR images in distinguishing between blood and lipid within ovarian masses. AJR Am J Roentgenol1992;158:321–325.
    MedlineGoogle Scholar
  • 12 TanakaYO, Yoshizako T, Nishida M, Yamaguchi M, Sugimura K, Itai Y. Ovarian carcinoma in patients with endometriosis: MR imaging findings. AJR Am J Roentgenol2000;175:1423–1430.
    MedlineGoogle Scholar
  • 13 MiyakoshiK, Tanaka M, Gabionza D, et al. Decidualized ovarian endometriosis mimicking malignancy. AJR Am J Roentgenol1998;171(6): 1625–1626.
    MedlineGoogle Scholar

Article History

Published in print: Mar 2006