Polypoid endometrioma mimicking malignant transformation: a case report and systematic review.

OBJECTIVE

To report a case of polypoid ovarian endometrioma mimicking malignant transformation, review the literature on this rare entity, and highlight its implications for surgical management and fertility preservation.

DESIGN

Case report and literature review.

SUBJECT: One reproductive-age woman with suspected malignant transformation of an ovarian endometrioma.

EXPOSURE: Laparoscopic adnexectomy.

MAIN OUTCOME MEASURE: Histopathologic confirmation of nonmalignant disease and review of surgical management in previously reported cases.

RESULTS

A 38-year-old woman desiring fertility preservation presented with a complex ovarian mass classified as O-RADS 4 on magnetic resonance imaging. Laparoscopic adnexectomy was performed for suspected malignancy. Final histopathologic examination confirmed a benign polypoid endometrioma. Review of the literature identified 22 reported cases, all managed surgically for presumed malignancy, with hysterectomy performed upfront in ten cases despite benign histology.

CONCLUSION

Polypoid ovarian endometrioma is a rare mimic of ovarian malignancy that may lead to extensive surgery before histologic confirmation. Awareness of this entity is essential to reduce overtreatment and to support fertility-preserving management when appropriate.