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The endoscopic localization of endometrial implants in the ovarian chocolate cyst
I A Brosens1, P J Puttemans, J Deprest
1Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
Objective:
To describe the characteristics of the endometrial cyst and to locate the implants for selective biopsy.
Design:
Prospective study.
Subjects:
Fifty-one women with one or two ovarian chocolate cysts of 3 cm or more were investigated.
Interventions:
Laparoscopy and random biopsy versus a new technique of ovarioscopy and selective biopsy.
Main Outcome Measure:
Visual characteristics and histopathology of endometrial cysts.
Results:
The clinical suspicion of an endometrioma was confirmed in a series of 59 hemorrhagic cysts by histopathology in 89% and 42%, respectively, of typical and atypical cases and in 27% of recurrent chocolate cysts in the presence of postoperative adhesions. The atraumatic technique of ovarioscopy allowed description of the typical characteristics of the inner wall of the endometrioma and location of the active implants for biopsy. Endometrial tissue was obtained by small ovarioscopy-guided biopsies in 82% of the cases versus 42% in large random biopsies. Red lesions were highly significant for a mucosa-type implant and were predominantly located at the site of invagination stigma and adhesions with the pelvic wall.
Conclusions:
Endoscopy of ovarian chocolate cysts allows observation of typical features of the wall that differentiates it from other benign cysts of the ovary. Microbiopsies obtained under endo-ovarian endoscopy provided significantly more active, endometrial tissue than random biopsies. The data confirm that in most cases the endometrioma is formed by invagination of the cortex and that active implants are located at the site of invagination. Ovarioscopy is therefore proposed as a useful tool to differentiate in doubtful cases between a hemorrhagic functional and an endometriotic cyst and to select the sites for biopsies.