A Rare Presentation of Polypoid Endometriosis of the Douglas Pouch: Case Report

TL;DR

A 46-year-old woman with abnormal bleeding had a rare case of polypoid endometriosis in the Douglas pouch, initially mistaken for a tumor on MRI.

Contribution

Highlights the rare presentation of polypoid endometriosis and its potential misdiagnosis as a malignancy.

Findings

MRI showed a mass near the uterus, initially suspected to be an ovarian tumor.

Histology confirmed the lesion was polypoid endometriosis from the Douglas pouch.

The case emphasizes the importance of MRI features in distinguishing benign from malignant lesions.

Abstract

A case is reported of a 46-year-old woman referred to a magnetic resonance imaging (MRI) for menometrorrhagia. MRI revealed a mass lesion lateral to the uterus fundus, suspicious of an ovarian granulosa cell tumor. Extensive surgery was performed. Histological examination revealed a polypoid endometriosis lesion arising from the Douglas pouch.

Teaching point: Polypoid endometriosis is a rare benign entity with a challenging differential diagnosis from malignancy. Specific MRI features can contribute to the diagnosis and thus avoid excessive surgical resection.

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