Endometriotic lesions mimicking advanced ovarian cancer - A case report and a review of the literature.

BACKGROUND: Approximately 2-5% of women affected by endometriosis are postmenopausal. The disease may simulate various malignancies. A case of endometriosis in a postmenopausal woman, spreading similarly to ovarian cancer, is reported. A broad review of existing literature on postmenopausal endometriosis, endometriosis involving the urinary tract, and the links between endometriosis and cancer are also presented.

CASE DESCRIPTION: A 51-year-old woman was diagnosed with a pelvic mass. She complained of pain in the lower abdomen that began three weeks prior, and had no history of dysmenorrhea, acyclic pelvic pain, or infertility. CT scan revealed a solid and cystic tumor in the region of the right adnexa, infiltrating the surrounding tissues, with possible infiltration of the urinary bladder, as well as soft-tissue lesions of the small intestinal mesentery. Bilateral hydronephrosis and distension of the ureters were also present. A malignant neoplasm of the ovary or the corpus uteri was suspected. Total abdominal hysterectomy and appendectomy were performed. A superficial infiltration of the urinary bladder was also excised. The pathology report revealed endometriotic foci in the tumor and in the bladder infiltration, as well as an endometriotic cyst in the right ovary. Two years postoperatively the patient is disease-free and in good condition.

CONCLUSIONS: Clinicians should remain conscious of the possibility of endometriosis mimicking advanced ovarian cancer and infiltrating the peritoneum and internal organs of the abdominal cavity, including the urinary tract. Imaging techniques, including CT and MRI, are not always effective in establishing the correct diagnosis preoperatively.