Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings
Abstract
Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic and multifocal disease with no known cure or preventive mechanisms. Patients may be asymptomatic or may experience chronic pelvic pain, dysmenorrhea, dyspareunia, or infertility. The pelvic cavity is the most common location for endometriotic implants, which usually affect the retrocervical space, ovaries, vagina, rectosigmoid colon, bladder dome, and round ligaments. Atypical endometriosis is rare and difficult to diagnose. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, umbilicus, inguinal area, breast, and pelvic nerves, as well as abdominal surgical scars. Gastrointestinal lesions are the most common extragenital manifestation, and the diaphragm is the most frequent extrapelvic site. The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) may help suggest the diagnosis, but imaging by specialists is fundamental to evaluation. Depending on the area affected, radiography, ultrasonography, thin-section computed tomography, or magnetic resonance imaging can be used to assess suspected lesions. Because isolated extragenital endometriosis is rare, concomitant evaluation of the pelvic cavity is mandatory. Surgical excision is the only therapeutic option for definitive treatment, and comprehensive disease mapping is necessary to avoid residual disease. The authors review atypical locations for endometriosis and emphasize the most appropriate imaging protocols for investigation of various clinical manifestations. Online supplemental material is available for this article. ©RSNA, 2018
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Certain studies involved oxidative stress with epigenetic alterations in DNA methylation in the pathogenesis of malignant transformation of endometriosis.
“Even though the pathogenesis of the malignant transformation of endometriosis remains unelucidated, certain studies involved oxidative stress with epigenetic alterations in DNA methylation [1,2,3,4].”
From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [4]
Many patients with umbilical endometriosis are diagnosed by physical examination and imaging modalities.
“Many patients with umbilical endometriosis are diagnosed by physical examination and imaging modalities.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [47]
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“Most patients are asymptomatic, but in some cases, they present with a variety of non-specific symptoms, which negatively affect their quality of life [4].”
Background
- Authors
- Chamié, L. P., Ribeiro, D. M. F. R., Tiferes, D. A., Macedo Neto, A. C. D., & Serafini, P. C.
- Affiliations
- Universidade de São Paulo (BR)
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.).
- Venue
- Radiographics
- Published
- 2018-01
- Volume
- 38
- Issue
- 1
- Pages
- 309-328
- ISSN
- 0271-5333 (ISSN-L)
- 1527-1323
- OpenAlex
- W2784276227
- Cited by
- 156
- References
- 46
- Citations by year
- 2026: 7 · 2025: 25 · 2024: 17 · 2023: 25 · 2022: 20 · 2021: 14 · 2020: 22 · 2019: 20 · 2018: 5 · 2013: 1
- FWCI
- 16.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiographics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- atypical endometriosis, extragenital endometriosis, gastrointestinal endometriosis, urinary tract endometriosis, diaphragmatic endometriosis, magnetic resonance imaging, computed tomography, ultrasonography, surgical excision
- MeSH terms
- Endometriosis, Female, Humans, Intestinal Diseases, Peritoneal Diseases, Thoracic Diseases
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