Polypoid endometriosis: a mimic of malignancy

Area of Science:

• Gynecologic Pathology
• Diagnostic Imaging
• Reproductive Endocrinology

Background:

• Polypoid endometriosis is a rare variant of endometriosis, histopathologically resembling an endometrial polyp.
• It predominantly affects peri- to postmenopausal women, often associated with hormone therapy or Tamoxifen use.
• Unlike classic endometriosis, it presents as a distinct clinical and imaging entity.

Purpose of the Study:

• To describe a case of polypoid endometriosis mimicking pelvic malignancy.
• To highlight the distinct clinical and imaging features of polypoid endometriosis.
• To emphasize the importance of recognizing this entity to avoid misdiagnosis.

Main Methods:

• Case presentation of a 60-year-old asymptomatic postmenopausal patient.
• Imaging studies (MRI) demonstrating a pelvic mass.
• Biopsy confirming polypoid endometriosis.
• Follow-up imaging after discontinuation of hormone replacement therapy.

Main Results:

• Incidental pelvic mass initially suspected as malignancy on imaging.
• Biopsy confirmed polypoid endometriosis.
• Mass size decreased after cessation of hormone replacement therapy.
• Characteristic imaging findings included a T2 hyperintense polypoid mass with a T2 hypointense rim, specific enhancement patterns, and no diffusion restriction.

Conclusions:

• Polypoid endometriosis is a rare entity that can mimic pelvic malignancy on imaging.
• Characteristic imaging features can aid in diagnosis.
• Familiarity with this variant is crucial for radiologists to prevent misdiagnosis and unnecessary aggressive treatment.