A 58-year-old postmenopausal woman with a 15-cm complex cystic right adnexal mass, uterine prolapse, and a large cystocele presented for a laparoscopy, total vaginal hysterectomy, bilateral salpingo-oophorectomy, and anterior and posterior colporrhaphy. She was on unopposed estrogen therapy for several years. Her past medical history was significant for borderline hypertension and interstitial cystitis.
Intraoperative findings included a 15-cm right adnexal cyst with approximately 500 mL clear fluid; a 10 × 7 × 4.5-cm uterus with anterior, small, subserosal fibroid; and normal left adnexa.
Gross pathologic findings included a benign endometrial polyp (Figure 1, white arrow), adenomyosis, and leiomyomata in the uterus, while the right ovary contained endometriosis, a simple serous cyst (Figure 1, black arrow), and a benign fibroma. The right adnexal soft tissue contained scattered polypoid nodules (Figure 1, arrowhead), which represented polypoid endometriosis (Figure 2) on microscopic examination.
Polypoid endometriosis is a rare manifestation of endometriosis that can be confused with a neoplasm on clinical, intraoperative, and pathologic examination. In some cases, polypoid endometriosis may be associated with unopposed estrogen therapy and may be the site of precancerous changes or, rarely, a neoplasm. In this case, the endometrial proliferation may be explained by the unopposed estrogen therapy and the presence of a benign fibroma in the right ovary with hormonal production.