Bilateral endometriotic cysts.


  • A 28 years old lady
  • Presented with dysmenorrhoea
  • Associated with menorrhagia
CT scan of abdomen pelvis in axial planes; post contrast soft tissue window
Reformatted CT abdomen pelvis in sagittal planes, soft tissue window post contrast
Reformatted CT abdomen pelvis in coronal planes post contrast soft tissue window

CT scan findings:

  • There are two well-defined cystic lesions in the pelvic region. These lesion lying to the right (yellow arrows) and left (red arrows) of the uterus measuring 4x6x7 cm and 4x5x6 cm respectively.
  • There are septations within the lesions.
  • No calcification or fat component within.
  • Post contrast images show contrast enhancement of wall and septa.
  • The uterus appears bulky with fluid within the uterine cavity.

Intraoperative findings:

  • Right endometriotic cyst measuring 5×5 cm, adhered to right fallopian tube and POD. Ruptured during manipulation, chocolate material drained.
  • Left endometriotic cyst multiloculated 4×6 cm, adhere to left fallopian tube and POD. Adhered to rectum. Left tube blocked.
  • Omentum, small bowel are normal.

HPE findings:

  • Macroscopy: Right and left cyst walls consist of multiple fragments of cyst wall.
  • Microscopy: Section shows dense fibrocollagenous cyst wall devoid of epithelial lining. There is foci of hemorrhage with numerous hemosiderin laden macrophages seen within the inner surface. No evidence of malignancy.
  • Interpretation: Endometriotic cysts

Diagnosis: Bilateral endometriotic cysts


  • Endometriotic cysts are also known as endometriomas are a localised form of endometriosis.
  • It is usually seen within the ovary. Other locations include cul-de-sac, posterior broad ligament, uterosacral ligament, uterus and colon.
  • Endometriomas contains dark degenerated blood products following repeated cyclical haemorrhage. The cysts may be up to 20 cm in size although they are usually smaller (2-5 cm).
Author: radhianahassan