Benign ovarian / Endometriosis

(OSCE slides )
Prepared by
Dr. Alaa Elsayed
Supervised by
Prof. Dr. Mohammed Hesham
 Q1
A
Two benign adnexal masses

1. What is the likely diagnosis of each condition

2. Mention two radiologic features of condition A
3. Mention two radiologic features of condition B

B
1. What is the likely diagnosis of each condition
A. Endometrioma A
B. Dermoid cyst

2. Mention two radiologic features of condition A

• Ground glass appearance
• Doppler – no blood flow

3. Mention two radiologic features of condition B

• Dermoid plug
• Dermoid mesh B
Endometrioma US

• The classic sonographic appearance of an

endometrioma is as follows: a cystic adnexal
mass separate from the ovary containing
diffuse low-level homogenous echoes often
described as a “ground glass” appearance .

• The lesion contours are often angular as a

result of adhesions or fibrosis. Often there is a
conglomeration of multiple cysts with angular
margins .

• Lesions, however, are usually monolocular and

rarely have septations.

• Color and spectral Doppler interrogation will

not demonstrate internal vascularity.
Endometrioma US

• Rarely, layering with fluid–fluid or fluid–

debris levels may be observed.
• More often a graduated change in
echogenicity from an anechoic
appearance superiorly to a more
echogenic texture dependently can be
seen.
• This has been described as “shading” and
is likely caused by suspension of the
gradually settling red blood cells or blood
products within the gelatinous contents
of the endometrioma .
• Echogenic foci may be noted in the
walls of endometriomas. The exact
pathologic basis of these foci has
not been established.
• Given the similarity to hyperechoic
gallbladder wall foci in hyperplastic
cholestasis, it has been postulated
that they may contain cholesterol
from the breakdown of cell
membranes .
 Q2

A woman complaining of
dysmenorrhea and
dyspareunia has this
laparoscopic picture

A. Most likely diagnosis

B. Mention 2 laparoscopic
features
C. Mention two theories
Findings — During laparoscopy, areas of peritoneal endometriosis appear as
• raised flame-like patches,
• whitish opacifications,
• yellow-brown discolorations,
• translucent blebs, or
• reddish or reddish-blue irregularly-shaped islands .
• The appearance of some blue/brown lesions has been described as "powder
burns."
• The peritoneal surface can be scarred or puckered, have defects (Allen-Masters
syndrome), or give rise to nodules or cysts.
• Rarely, endometriosis appears as a polyploid mass, which may mimic the
appearance of malignant tumor.
• Dense fibrous adhesions signify severe disease.
a. Retrograde menstruation
b. Lymphatic spread
c. Vascular spread
d. Coelomec metaplasia
 Q3
• Endometriosis fertility Index (EFI ) was
calculated for 24 year old woman
• Primary infertility – 2 years
Laparoscopic findings
• peritoneal endometriosis measuring 2 cm
• Normal findings of tubes , fimbriae and ovaries
except for
• Mild serosal injury of right tube which does not
affect its function
• Absent left ovary ( removed during prior
surgery for large ovarian cyst )

1. Mention two historic factors

2. Mention two surgical factors
3. When least function is scored zero
 Score
Stage I (minimal ) -------- 1 to 5

Stage II (mild ) -------- 6 to 15

Stage III (moderate) -------- 16 to 40

Stage IV (severe) -------- >40

 Q4
International Ovarian Tumor Analysis ( IOTA ) – simple rules

A. Mention two B features

B. Mention two M features
C. Apply simple rules on the attached image
Thank
You