Endometriosis and ascites

A 29-year-old black woman had increasing abdominal girth, dullness to percussion, and an irregular mass in the left adnexal region. At laparotomy, 6 L of dark brown fluid was removed, and the abdominal cavity had the appearance of extensive carcinomatosis. Subsequent histology was consistent with endometriosis. Fourteen cases of endometriosis producing symptoms resembling ovarian cancer have been previously reported. Of the 10 patients whose race was mentioned, 9 were black, as was our patient. The etiology of the ascites is unknown. Histologically, the endometrial implants show dense stroma and a slightly hyperplastic epithelium rather than the physiologic proliferative endometrium usually associated with endometriosis. This leads us to question the prognosis of the lesion despite its apparently benign histology.