背景:子宫内膜瘤是一种由异位子宫内膜组织出血产生的变性血液制品组成的卵巢囊肿。子宫内膜瘤可以破裂,导致腹膜积血,并表现出与其他人相似的体征和症状,更常见的腹部急症.因此,他们通常不会在术前诊断。超声和横断面成像可以帮助诊断子宫内膜瘤。我们介绍了一例子宫内膜瘤破裂导致大量腹膜积血的病例,最初被怀疑代表恶性肿瘤伴癌病。
方法:一名32岁的西班牙裔女性在6个月内出现剧烈腹痛和15磅的意外体重减轻。实验室工作对于妊娠试验阴性和癌症抗原125升高具有重要意义。腹部和骨盆的计算机断层扫描显示左附件中有13厘米的复杂囊性肿块,伴有中度高密度腹水和网膜结节。超声显示一个大的左附件复合体囊结构,内部回声,和胸部计算机断层扫描显示没有胸内肿瘤或感染过程的迹象。她的报告涉及恶性肿瘤和癌变。来自穿刺术的液体被送去培养和细胞学。诊断性腹腔镜检查显示左卵巢已被子宫内膜瘤完全取代,上面有一个小的破裂区域。囊肿上存在子宫内膜异位症的棕色沉积物,网膜,和各种腹膜衬里。子宫内膜的组织样本,子宫肌层,子宫颈,卵巢,输卵管,腹膜,网膜,取下副结肠空间,没有增生,发育不良,或病理上的恶性细胞。
结论:当绝经前女性在没有创伤的情况下出现腹膜积血并伴有复杂附件囊性肿块时,应将破裂的子宫内膜瘤和破裂的出血性囊肿纳入鉴别诊断。在子宫内膜瘤破裂的情况下,癌抗原125和癌抗原19-9可以错误地升高。
BACKGROUND: Endometriomas are a type of ovarian cyst composed of degenerated blood products from hemorrhage of ectopic endometrial tissue. Endometriomas can rupture, causing hemoperitoneum, and present with signs and symptoms similar to other, more common abdominal emergencies. Therefore, they are not often diagnosed preoperatively. Ultrasound and cross-sectional imaging can assist in diagnosis of endometriomas. We present a
case of ruptured endometrioma causing massive hemoperitoneum that was initially suspected to represent malignancy with carcinomatosis.
METHODS: A 32-year-old Hispanic woman presented with sharp abdominal pain and 15-pound unintentional weight loss over 6 months. Laboratory work was significant for a negative pregnancy test and elevated cancer antigen-125. Computed tomography of the abdomen and pelvis demonstrated a 13-cm complex cystic mass in the left adnexa with moderate hyperdense ascites and omental nodularity. Ultrasound demonstrated a large left adnexal complex cystic structure with internal echoes, and chest computed tomography showed no signs of intrathoracic neoplastic or infectious processes. Her presentation was concerning for malignancy with carcinomatosis. Fluid from a paracentesis was sent for culture and cytology. Diagnostic laparoscopy revealed that the left ovary had been completely replaced by an endometrioma, which had a small ruptured area superiorly. Brown deposits of endometriosis were present on the cyst, omentum, and various peritoneal linings. Tissue samples of the endometrium, myometrium, cervix, ovaries, fallopian tubes, peritoneum, omentum, and paracolic spaces were taken and showed no hyperplastic, dysplastic, or malignant cells on pathology.
CONCLUSIONS: Ruptured endometrioma and ruptured hemorrhagic cyst should be included in the differential diagnosis when a premenopausal female presents with hemoperitoneum in combination with complex adnexal cystic masses in the absence of trauma. Cancer antigen-125 and cancer antigen 19-9 can be falsely elevated in the setting of ruptured endometrioma.