Zwierzchowska A, Panek G, Gajewska M, Barcz E
Eur J Gynaecol Oncol. 2017;38(2):303-307.
Approximately 2-5% of women affected by endometriosis are postmenopausal. The disease may simulate various malignancies. A case of endometriosis in a postmenopausal woman, spreading similarly to ovarian cancer, is reported. A broad review of existing literature on postmenopausal endometriosis, endometriosis involving the urinary tract, and the links between endometriosis and cancer are also presented.
A 51-year-old woman was diagnosed with a pelvic mass. She complained of pain in the lower abdomen that began three weeks prior, and had no history of dysmenorrhea, acyclic pelvic pain, or infertility. CT scan revealed a solid and cystic tumor in the region of the right adnexa, infiltrating the surrounding tissues, with possible infiltration of the urinary bladder, as well as soft-tissue lesions of the small intestinal mesentery. Bilateral hydronephrosis and distension of the ureters were also present. A malignant neoplasm of the ovary or the corpus uteri was suspected. Total abdominal hysterectomy and appendectomy were performed. A superficial infiltration of the urinary bladder was also excised. The pathology report revealed endometriotic foci in the tumor and in the bladder infiltration, as well as an endometriotic cyst in the right ovary. Two years postoperatively the patient is disease-free and in good condition.
Clinicians should remain conscious of the possibility of endometriosis mimicking advanced ovarian cancer and infiltrating the peritoneum and internal organs of the abdominal cavity, including the urinary tract. Imaging techniques, including CT and MRI, are not always effective in establishing the correct diagnosis preoperatively.
约2%-5%的子宫内膜异位症患者为绝经后女性。该疾病可能类似多种恶性肿瘤。本文报告一例绝经后女性的子宫内膜异位症病例，其扩散方式与卵巢癌相似。同时还对现有的关于绝经后子宫内膜异位症、累及泌尿系统的子宫内膜异位症以及子宫内膜异位症与癌症之间联系的文献进行了广泛综述。
一名51岁女性被诊断出盆腔肿块。她主诉三周前开始出现下腹部疼痛，既往无痛经、非周期性盆腔疼痛或不孕史。CT扫描显示右附件区有一个实性和囊性肿瘤，浸润周围组织，可能浸润膀胱，同时小肠系膜有软组织病变。双侧肾盂积水和输尿管扩张也存在。怀疑为卵巢或子宫体恶性肿瘤。行全腹子宫切除术和阑尾切除术。还切除了膀胱的浅表浸润部分。病理报告显示肿瘤及膀胱浸润处有子宫内膜异位病灶，右卵巢有一个子宫内膜异位囊肿。术后两年患者无疾病复发，状况良好。
临床医生应始终意识到子宫内膜异位症可能模仿晚期卵巢癌并浸润腹腔的腹膜和内脏器官，包括泌尿系统。包括CT和MRI在内的成像技术在术前并不总是能有效做出正确诊断。
