| Author: Eva Račanská
Description:
35 year old I gravida I para schedulled for diagnostic laparoscopy due to the ultrasound finding of bilateral ovarian cysts. Patient is followed up for hypothyreosis, hypertension and lung sarcoidosis. She was on corticoids but this treatment was terminated 6 months ago. Her menstrual cycle is irregular and complains of dysmenorrhoe. She suffers from a chronic pelvic pain. Bimanual pelvic examination shows sligthly enlarged uterus of uneven surface, both adnexal regions tender to palpation but difficult to examine. Transvaginal ultrasound shows enlarged uterus 95 mm in long axis, endometrium 10 mm, on the right - trilocular cyst 85 mm in diameter, left ovary 53 by 54 mm with 3 anechogenic cysts 33, 25, 24 mm in diameter. Tumor markers: Ca 125 lightly elevated. Diagnostic laparoscopy was performed with the following findings. Right ovary was almost destructed by the endometrial cyst 80 mm in diameter which was adhering to the ovarian fossa and pouch of Douglas. Left ovary was enlarged with the endometrial cyst 40 mm in diameter and adhered to the left ovarian fossa. Both cysts contained chocolate like content. Both uterine tubes were of normal shape with no abnormalities. The pouch of Douglas and sacrouterine ligaments with numerous endometrial implants. The left ovarian cyst was exstirpated and bleeding spots were coagulated. The wall of the right ovarian cyst was cut and chocolate like fluid was drained, exstirpation of the cyst wall was performed afterwards. The histology confirmed Endometrioma, Sampson cyst of both ovaries. Patient was schedulled for 6 months course of GnRH analogue therapy because of the endometriosis of grade 3-4 and wanted pregnancy.
Categorization:
Endometrioma - Sampson cyst, Endometriosis
Attachments:
Description: We can see uterus at the back and the surface of the large cyst of the right ovary.
Description: Enlarged left ovary with the endometrial cyst.
Description: Uterus at the back left ovary and grossly enlarged right ovary.
Description: Left uterine tube, left ovary after exstirpation and the pouch of Douglas after adhesiolysis.
Description: Right ovary after exstirpation of the cyst, numerous endometrial implants.
Description: Uterus and both ovaries after endometrial cyst exstirpation.
Description: Uterus, left uterine tube and both ovaries after cyst exstirpation, large number of endometrial implants.
Description: Endometrial implant in the pelvic wall.
Description: Severe case of pelvic endometriosis, several endometrial implants.Both ovaries after exstirpation of the endometrioma.