Department of Obstetrics and Gynecology, Lin-Shin Medical Corporation/Lin-Shin Hospital, Taichung 408, Taiwan, China.
Chin Med J (Engl). 2011 Feb;124(4):627-30.
Endometriosis coexisting with a dermoid cyst of the ovary is extraordinarily rare, although both these benign conditions are said to be common in women in the reproductive age group. There are only two previous case reports,which is evident from our literature review from January 1960 through January 2010. Acute abdomen is one of the greatest diagnostic challenges and easily ignored by the clinicians to exclude the possibility of gynecologic illness. A 35-year-old woman was referred by the doctor in Family clinic. She experienced a three-day period of severe right lower abdominal pain and intermittent vomiting. Ultrasonography identified a bilocular, cystic, hypoechoic, and hyperechoic tumor, 7 cm × 6 cm × 6 cm in the right adnexal region. Laparoscopic cystectomy was performed under the impression of ovarian cyst with torsion or hemorrhage. The frozen section was benign and appendiceal status was adequate. Histopathologic examination described an ovarian cyst composed of endometrial-type lining with stromacells (endometriosis) and benign teratoma tissue with plenty of skin appendages and sebaceous glands. We report this unusual and interesting ovarian mass to remind physicians that the usage of the Endobag after cystectomy, the benefits on minimizing operative time, spilled opportunity, and postoperative complications. Laparoscopic techniques for large ovarian masses might be considered. The experience of the surgeon is also very important to prevent misdiagnosis or complication. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst as a separate pathology in single ovary of such a nature. It also presents a challenge to the clinicians and to the pathologists.
卵巢子宫内膜异位囊肿并存皮样囊肿极为罕见，尽管这两种良性疾病据称在育龄妇女中很常见。通过我们从 1960 年 1 月到 2010 年 1 月的文献回顾，仅发现有两例之前的病例报告。急性腹痛是最大的诊断挑战之一，很容易被临床医生忽视，以排除妇科疾病的可能性。一名 35 岁的妇女由家庭诊所的医生转介而来。她经历了三天的右下腹痛和间歇性呕吐。超声检查发现右侧附件区有一个 7cm×6cm×6cm 的双房囊性低回声和高回声肿瘤。在卵巢囊肿扭转或出血的印象下进行腹腔镜下囊肿切除术。冷冻切片为良性，阑尾状态良好。组织病理学检查描述了一个卵巢囊肿，由子宫内膜样衬里和基质细胞（子宫内膜异位症）组成，并有大量皮肤附属物和皮脂腺的良性畸胎瘤组织。我们报告这个不寻常和有趣的卵巢肿块，以提醒医生在囊肿切除术后使用内袋的好处，可最大限度地减少手术时间、机会损失和术后并发症。对于大型卵巢肿块，也可以考虑使用腹腔镜技术。外科医生的经验也非常重要，可以防止误诊或并发症。对于这种单侧卵巢同时存在卵巢子宫内膜异位症和偶然皮样囊肿的情况，需要进一步随访，因为这是一种单独的病理。这也对临床医生和病理学家提出了挑战。
