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Endometriosis: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (P.J.W.) and Gynecologic and Breast Pathology (T.P.M.), Armed Forces Institute of Pathology, Bldg 54, Room M-121, Washington, DC 20306-6000; the Department of Radiology, Oregon Health Sciences University, Portland (R.S.); and the Department of Radiology, University of Utah, Salt Lake City (P.J.W.). Received July 7, 2000; revision requested July 24; revision received August 1; accepted August 3. Address correspondence to P.J.W. (e-mail: woodwardp@afip.osd.mil).

Endometriosis is an important gynecologic disorder primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus. It may vary from microscopic endometriotic implants to large cysts (endometriomas). The physical manifestations are protean, with some patients being asymptomatic and others having disabling pelvic pain, infertility, or adnexal masses. Symptoms do not necessarily correlate with the severity of the disease. Ultrasonographic (US) features are variable and can mimic those of other benign and malignant ovarian lesions. Low-level internal echoes and echogenic wall foci are more specific US features for endometriomas. Magnetic resonance imaging improves diagnostic accuracy, with endometriotic cysts typically appearing with high signal intensity on T1-weighted images and demonstrating "shading" on T2-weighted images. The ovaries are the most common sites affected, but endometriosis can also involve the gastrointestinal tract, urinary tract, chest, and soft tissues. Small implants and adhesions are not well evaluated radiologically; therefore, laparoscopy remains the standard of reference for diagnosis and staging. Both medical and surgical treatment options are available depending on the patient's specific case.

Index Terms: Endometriosis, 70.318, 80.3192

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