Endometriotic cyst

Case contribution: Dr Radhiana Hassan


  • A 41 years old
  • Presented with acute onset abdominal pain
  • No fever, no bowel habit change.
  • No constitutional symptoms
CT scan abdomen and pelvis in axial plane soft tissue window post contrast

CT scan findings:

  • The uterus is bulky iwth inhomogenous parenchymal enhancement
  • There is a complex cystic-solid lesion in the left adnexa
  • The lesion measures 6x5x3 cm.
  • There is enhancing region at the superomedial surface.
  • Parametrial streakiness with few shotty nodes
  • No ascites

Intra-operative findings:

  • Left endometrioma about 6×6 cm
  • POD is obliterated
  • Adhesion of the uterus to the rectum posteriorly
  • The left fallopian tube and left ovary embedded to the posterior of uterus
  • Right ovary and right fallopian tube is normal
  • Endometriotic spots noted at the fundus of uterus.
  • No endometriotic spots at the bowel

HPE findings:

  • Macroscopy: specimen labelled as left ovary and cyst wall consist of ruptured cystic lesion measuring 38x25x25 mm and 2-5 mm thickness.
  • Microscopy: section shows multiple pieces of ovarian cyst wall with areas of hemorrhage. The cyst walls are lined by hemorrhagic endometrial stroma with some areas show presence of endometrial epithelium. A few foci of microcalcification are noted. No evidence of malignancy.
  • Interpretation: compatible with endometriotic cysts

Diagnosis: Endometriotic cysts


  • Endometriotics cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries.
  • It is also known as chocholate cyst due to its appearance of brown, tar-like appearance, looking something like melted chocolate. The colour comes from old menstrual blood and tissue that fills the cavity of the cyst.
  • An endometriotic cyst can affect one or both ovaries, and may occur in multiples or singularly.
  • It occurs in 20-40% of women having endometriosis.
  • Endometriotic cysts can place a a woman of reproductive age at a higher risk for ovarian cancer, can cause pelvic pain, contribute to infertility, decrease ovarian function and interfere with assisted reproductive technologies.
Author: radhianahassan