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• W4229058977 abstract "In a symptomatic, 47-year-old woman with dysmenorrhea, dyschezia, and rectal bleeding, a transvaginal ultrasound demonstrated adenomyosis and an irregular hypoechoic nodule of 31 mm×12 mm×24 mm that infiltrated the anterior rectal wall and caused a retraction compatible with deep infiltrating endometriosis (Figure 1). After an elastography was conducted, the nodule stiffness was observed to be high (Figures 2 and 3). After a transvaginal scan following the intrarectal introduction of a physiological solution (Video), the nodule appeared to infiltrate the submucosa for 3 mm and caused 50% lumen stenosis (Figure 4). Contrary to what is reported for endometriomas, no specific sonographic signs of malignant transformation were evident. Total hysterectomy and partial rectal resection were performed by laparoscopy. Histopathology confirmed adenomyosis and revealed a moderately differentiated endometrioid adenocarcinoma, developed on a deep endometriosis of the rectum. Malignant transformation of endometriosis occurs in 0.7% to 2.5% of women, mainly after 45 years of age. Seventy-five percent of cases involve the ovaries and 25% involve extragonadal sites, mostly the rectum-sigmoid. Figure 2Transvaginal elastography Show full caption The black-marked blue area represents the high-stiffness endometriosis nodule at transvaginal elastography. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022. View Large Image Figure Viewer Download Hi-res image Figure 3Analysis of the transvaginal elastography Show full caption At elastography analysis the yellow circular area placed in the middle of the nodule proved the presence of high-stiffness tissue with an objective value of 0.05% (in the graphic), whereas the light blue circular area placed in the pericervical tissue showed the presence of soft tissue with an objective value of 0.47%. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022. View Large Image Figure Viewer Download Hi-res image Figure 4Transvaginal scan Show full caption At transvaginal scan, the nodule marked by the yellow tract infiltrating the submucosa for 3 mm (yellow arrow) narrows the rectal lumen by about 50%. D1 represents the minimum lumen diameter of the affected rectal wall. D2 is the normal rectal lumen diameter. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022. View Large Image Figure Viewer Download Hi-res image The black-marked blue area represents the high-stiffness endometriosis nodule at transvaginal elastography. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022. At elastography analysis the yellow circular area placed in the middle of the nodule proved the presence of high-stiffness tissue with an objective value of 0.05% (in the graphic), whereas the light blue circular area placed in the pericervical tissue showed the presence of soft tissue with an objective value of 0.47%. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022. At transvaginal scan, the nodule marked by the yellow tract infiltrating the submucosa for 3 mm (yellow arrow) narrows the rectal lumen by about 50%. D1 represents the minimum lumen diameter of the affected rectal wall. D2 is the normal rectal lumen diameter. Xholli. Sonographic appearance of malignant deep endometriosis of the rectum. Am J Obstet Gynecol 2022." @default.
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• W4229058977 date "2022-05-01" @default.
• W4229058977 modified "2023-10-06" @default.
• W4229058977 title "Sonographic appearance of malignant deep endometriosis of the rectum" @default.
• W4229058977 doi "https://doi.org/10.1016/j.ajog.2021.11.014" @default.
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