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Endometrioma
Maryam Rezvani, MD; Jeffrey Dee Olpin, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Endometriotic cyst
          • "Chocolate" cyst
        • Definitions

          • Cystic ovarian mass resulting from repeated hemorrhage of endometrial tissue implants in response to hormonal stimulation

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Hindman N et al: Imaging spectrum of endometriosis (endometriomas to deep infiltrative endometriosis). Radiol Clin North Am. 58(2):275-89, 2020
                                      2. Moro F et al: Ultrasound imaging in endometriosis. Obstet Gynecol Clin North Am. 46(4):643-59, 2019
                                      3. Exacoustos C et al: Isolated ovarian endometrioma: a history between myth and reality. J Minim Invasive Gynecol. 25(5):884-91, 2018
                                      4. Van den Bosch T et al: Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Pract Res Clin Obstet Gynaecol. 51:16-24, 2018
                                      5. Corwin MT et al: Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 271(1):126-32, 2014
                                      6. Chaudhry S et al: Detection and differential diagnosis of suspected malignant transformation of an endometrioma during pregnancy. BMJ Case Rep. 2013:bcr2012007744, 2013
                                      7. Khashper A et al: T2-hypointense adnexal lesions: an imaging algorithm. Radiographics. 32(4):1047-64, 2012
                                      8. McDermott S et al: MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics. 32(3):845-63, 2012
                                      9. Siegelman ES et al: MR imaging of endometriosis: ten imaging pearls. Radiographics. 32(6):1675-91, 2012
                                      10. Lee YR: CT imaging findings of ruptured ovarian endometriotic cysts: emphasis on the differential diagnosis with ruptured ovarian functional cysts. Korean J Radiol. 12(1):59-65, 2011
                                      11. Tsili AC et al: Malignant transformation of an endometriotic cyst: MDCT and MR findings. J Radiol Case Rep. 5(1):9-17, 2011
                                      12. Bennett GL et al: Unusual manifestations and complications of endometriosis--spectrum of imaging findings: pictorial review. AJR Am J Roentgenol. 194(6 Suppl):WS34-46, 2010
                                      13. Dujardin M et al: Cystic lesions of the female reproductive system: a review. JBR-BTR. 93(2):56-61, 2010
                                      14. Tanaka YO et al: MRI of endometriotic cysts in association with ovarian carcinoma. AJR Am J Roentgenol. 194(2):355-61, 2010
                                      15. Takeuchi M et al: Susceptibility-weighted MRI of endometrioma: preliminary results. AJR Am J Roentgenol. 191(5):1366-70, 2008
                                      16. Asch E et al: Variations in appearance of endometriomas. J Ultrasound Med. 26(8):993-1002, 2007
                                      17. Kinkel K et al: Diagnosis of endometriosis with imaging: a review. Eur Radiol. 16(2):285-98, 2006
                                      18. Lee SI: Radiological reasoning: imaging characterization of bilateral adnexal masses. AJR Am J Roentgenol. 187(3 Suppl):S460-6, 2006
                                      19. Fruscella E et al: Sonographic features of decidualized ovarian endometriosis suspicious for malignancy. Ultrasound Obstet Gynecol. 24(5):578-80, 2004
                                      20. Wu TT et al: Magnetic resonance imaging of ovarian cancer arising in endometriomas. J Comput Assist Tomogr. 28(6):836-8, 2004
                                      21. Sala EJ et al: Magnetic resonance imaging of benign adnexal disease. Top Magn Reson Imaging. 14(4):305-27, 2003
                                      22. Zanardi R et al: Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging. 28(5):733-42, 2003
                                      23. Glastonbury CM: The shading sign. Radiology. 224(1):199-201, 2002
                                      24. Modesitt SC et al: Ovarian and extraovarian endometriosis-associated cancer. Obstet Gynecol. 100(4):788-95, 2002
                                      25. Alcazar JL: Transvaginal colour Doppler in patients with ovarian endometriomas and pelvic pain. Hum Reprod. 16(12):2672-5, 2001
                                      26. Woodward PJ et al: Endometriosis: radiologic-pathologic correlation. Radiographics. 21(1):193-216; questionnaire 288-94, 2001
                                      27. Patel MD et al: Endometriomas: diagnostic performance of US. Radiology. 210(3):739-45, 1999
                                      28. Guerriero S et al: Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma. Obstet Gynecol. 88(3):403-7, 1996
                                      29. Ha HK et al: Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images. AJR Am J Roentgenol. 163(1):127-31, 1994
                                      30. Outwater E et al: Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study. Radiology. 186(2):489-94, 1993
                                      31. Togashi K et al: Endometrial cysts: diagnosis with MR imaging. Radiology. 180(1):73-8, 1991
                                      32. Zawin M et al: Endometriosis: appearance and detection at MR imaging. Radiology. 171(3):693-6, 1989
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • Endometriotic cyst
                                              • "Chocolate" cyst
                                            • Definitions

                                              • Cystic ovarian mass resulting from repeated hemorrhage of endometrial tissue implants in response to hormonal stimulation

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Ultrasonographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Hindman N et al: Imaging spectrum of endometriosis (endometriomas to deep infiltrative endometriosis). Radiol Clin North Am. 58(2):275-89, 2020
                                                                          2. Moro F et al: Ultrasound imaging in endometriosis. Obstet Gynecol Clin North Am. 46(4):643-59, 2019
                                                                          3. Exacoustos C et al: Isolated ovarian endometrioma: a history between myth and reality. J Minim Invasive Gynecol. 25(5):884-91, 2018
                                                                          4. Van den Bosch T et al: Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Pract Res Clin Obstet Gynaecol. 51:16-24, 2018
                                                                          5. Corwin MT et al: Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 271(1):126-32, 2014
                                                                          6. Chaudhry S et al: Detection and differential diagnosis of suspected malignant transformation of an endometrioma during pregnancy. BMJ Case Rep. 2013:bcr2012007744, 2013
                                                                          7. Khashper A et al: T2-hypointense adnexal lesions: an imaging algorithm. Radiographics. 32(4):1047-64, 2012
                                                                          8. McDermott S et al: MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics. 32(3):845-63, 2012
                                                                          9. Siegelman ES et al: MR imaging of endometriosis: ten imaging pearls. Radiographics. 32(6):1675-91, 2012
                                                                          10. Lee YR: CT imaging findings of ruptured ovarian endometriotic cysts: emphasis on the differential diagnosis with ruptured ovarian functional cysts. Korean J Radiol. 12(1):59-65, 2011
                                                                          11. Tsili AC et al: Malignant transformation of an endometriotic cyst: MDCT and MR findings. J Radiol Case Rep. 5(1):9-17, 2011
                                                                          12. Bennett GL et al: Unusual manifestations and complications of endometriosis--spectrum of imaging findings: pictorial review. AJR Am J Roentgenol. 194(6 Suppl):WS34-46, 2010
                                                                          13. Dujardin M et al: Cystic lesions of the female reproductive system: a review. JBR-BTR. 93(2):56-61, 2010
                                                                          14. Tanaka YO et al: MRI of endometriotic cysts in association with ovarian carcinoma. AJR Am J Roentgenol. 194(2):355-61, 2010
                                                                          15. Takeuchi M et al: Susceptibility-weighted MRI of endometrioma: preliminary results. AJR Am J Roentgenol. 191(5):1366-70, 2008
                                                                          16. Asch E et al: Variations in appearance of endometriomas. J Ultrasound Med. 26(8):993-1002, 2007
                                                                          17. Kinkel K et al: Diagnosis of endometriosis with imaging: a review. Eur Radiol. 16(2):285-98, 2006
                                                                          18. Lee SI: Radiological reasoning: imaging characterization of bilateral adnexal masses. AJR Am J Roentgenol. 187(3 Suppl):S460-6, 2006
                                                                          19. Fruscella E et al: Sonographic features of decidualized ovarian endometriosis suspicious for malignancy. Ultrasound Obstet Gynecol. 24(5):578-80, 2004
                                                                          20. Wu TT et al: Magnetic resonance imaging of ovarian cancer arising in endometriomas. J Comput Assist Tomogr. 28(6):836-8, 2004
                                                                          21. Sala EJ et al: Magnetic resonance imaging of benign adnexal disease. Top Magn Reson Imaging. 14(4):305-27, 2003
                                                                          22. Zanardi R et al: Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging. 28(5):733-42, 2003
                                                                          23. Glastonbury CM: The shading sign. Radiology. 224(1):199-201, 2002
                                                                          24. Modesitt SC et al: Ovarian and extraovarian endometriosis-associated cancer. Obstet Gynecol. 100(4):788-95, 2002
                                                                          25. Alcazar JL: Transvaginal colour Doppler in patients with ovarian endometriomas and pelvic pain. Hum Reprod. 16(12):2672-5, 2001
                                                                          26. Woodward PJ et al: Endometriosis: radiologic-pathologic correlation. Radiographics. 21(1):193-216; questionnaire 288-94, 2001
                                                                          27. Patel MD et al: Endometriomas: diagnostic performance of US. Radiology. 210(3):739-45, 1999
                                                                          28. Guerriero S et al: Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma. Obstet Gynecol. 88(3):403-7, 1996
                                                                          29. Ha HK et al: Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images. AJR Am J Roentgenol. 163(1):127-31, 1994
                                                                          30. Outwater E et al: Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study. Radiology. 186(2):489-94, 1993
                                                                          31. Togashi K et al: Endometrial cysts: diagnosis with MR imaging. Radiology. 180(1):73-8, 1991
                                                                          32. Zawin M et al: Endometriosis: appearance and detection at MR imaging. Radiology. 171(3):693-6, 1989