Mascilini F, Moruzzi C, Giansiracusa C, Guastafierro F, Savelli L, De Meis L, Epstein E, Timor-Tritsch I E, Mailath-Pokorny M, Ercoli A, Exacoustos C, Benacerraf B R, Valentin L, Testa A C
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Ultrasound Obstet Gynecol. 2014 Sep;44(3):354-60. doi: 10.1002/uog.13323.
To describe the clinical history and ultrasound findings in women with decidualized endometriomas surgically removed during pregnancy.
In this retrospective study, women with a histological diagnosis of decidualized endometrioma during pregnancy who had undergone preoperative ultrasound examination were identified from the databases of seven ultrasound centers. The ultrasound appearance of the tumors was described on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) by one author from each center using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, two authors reviewed together available digital ultrasound images and used pattern recognition to describe the typical ultrasound appearance of decidualized endometriomas.
Eighteen eligible women were identified. Median age was 34 (range, 20-43) years. Median gestational age at surgical removal of the decidualized endometrioma was 18 (range, 11-41) weeks. Seventeen women (94%) were asymptomatic and one presented with pelvic pain. In three of the 18 women an ultrasound diagnosis of endometrioma had been made before pregnancy. The original ultrasound examiner was uncertain whether the mass was benign or malignant in 10 (56%) women and suggested a diagnosis of benignity in nine (50%) women, borderline in eight women (44%), and invasive malignancy in one (6%) woman. Seventeen decidualized endometriomas contained a papillary projection, and in 16 of these at least one of the papillary projections was vascularized at power or color Doppler examination. The number of cyst locules varied between one (n = 11) and four. No woman had ascites. When using pattern recognition, most decidualized endometriomas (14/17, 82%) were described as manifesting vascularized rounded papillary projections with a smooth contour in an ovarian cyst with one or a few cyst locules and ground-glass or low-level echogenicity of the cyst fluid.
Rounded vascularized papillary projections with smooth contours within an ovarian cyst with cyst contents of ground-glass or low-level echogenicity are typical of surgically removed decidualized endometriomas in pregnant women, most of whom are asymptomatic.
描述孕期手术切除的蜕膜样变子宫内膜瘤患者的临床病史及超声表现。
在这项回顾性研究中，从7个超声中心的数据库中筛选出孕期经组织学诊断为蜕膜样变子宫内膜瘤且术前行超声检查的女性。每个中心的一名作者根据超声图像、超声报告和研究方案（如适用），使用国际卵巢肿瘤分析（IOTA）组的术语和定义描述肿瘤的超声表现。此外，两名作者共同回顾可用的数字超声图像，并使用模式识别来描述蜕膜样变子宫内膜瘤的典型超声表现。
共识别出18例符合条件的女性。中位年龄为34岁（范围20 - 43岁）。手术切除蜕膜样变子宫内膜瘤时的中位孕周为18周（范围11 - 41周）。17名女性（94%）无症状，1名出现盆腔疼痛。18名女性中有3名在怀孕前超声诊断为子宫内膜瘤。最初的超声检查者在10名（56%）女性中不确定肿块是良性还是恶性，9名（50%）女性提示良性诊断，8名（44%）女性提示交界性诊断，1名（6%）女性提示浸润性恶性诊断。17个蜕膜样变子宫内膜瘤包含乳头状突起，其中16个在能量或彩色多普勒检查中至少有一个乳头状突起有血管化。囊肿小腔的数量在1个（n = 11）至4个之间。无女性有腹水。使用模式识别时，大多数蜕膜样变子宫内膜瘤（14/17，82%）被描述为在有一个或几个囊肿小腔的卵巢囊肿中表现为有血管化的圆形乳头状突起，轮廓光滑，囊肿液呈磨砂玻璃样或低回声。
卵巢囊肿内轮廓光滑的圆形血管化乳头状突起，囊肿内容物呈磨砂玻璃样或低回声，是孕期手术切除的蜕膜样变子宫内膜瘤的典型表现，这些患者大多无症状。
