ARC Journal of Gynecology and Obstetrics Volume 2, Issue 3, 2017, PP 11-12 ISSN 2456-0561 DOI: http://dx.doi.org/10.20431/2456-0561.0203003 www.arcjournals.org

It May Happen: from Hemorrhagic

Juan Piazze1*, Ettore Palma2, Francesco Recchia3, Cristina Galligani4, Silvio Rea5 1ASL Frosinone (Poliambulatorio di Ceprano-Ospedale SS Trinità di Sora), Fondazione Carlo Ferri, Monterotondo, Rome 2Department of Gynecological Obstetrics and Urologic Sciences of "Sapienza" University of Rome 3Ospedale Civile di Avezzano, Fondazione “Carlo Ferri”, Monterotondo, Rome 4Analisi e Diagnostica Neomedica, Rome 5Chirurgia Oncologica, Università degli Studi de L’Aquila, Dpt DISCAB, Fondazione “Carlo Ferri”, Monterotondo, Rome

*Corresponding Author: Juan Piazze, ASL Frosinone (Poliambulatorio di Ceprano-Ospedale SS Trinità di Sora), Fondazione Carlo Ferri, Monterotondo, Rome, Email: [email protected]

Abstract: High Doppler resistive indices in a hemorrhagic corpus luteum suggest a possible an eventful transformation to endometrioma. Keywords: Endometrioma, hemorrhagic corpus luteum, ultrasound.

1. INTRODUCTION 2. CASE REPORT The demonstration of a direct transition to A 38 year old patient, G0 P0, with no sexual endometrioma from a follicle or a hemorrhagic intercourses referred, was sent to our Institution corpus luteum has been described in few for a clinical examination after long periods, studies, it remains the classical theory even months without menses and was sent to describing pathogenesis of from our Institution two weeks before a mild blood entrapment of blood due to invagination of the spotting. superficial ovarian coelomic epithelium with Transabdominal ultrasound pelvic examination subsequent metaplasia in typical glandular performed in 8° day of menses revealed an epithelium and stroma has been described by endometrial pattern (linear) not in agree with the Nisolle and Donnez (1). It sometimes may result menstrual period, while nothing abnormal was impossible to think that an endometrioma may seen in the adnexa. develop from a functional structure such as a corpus luteum, however it is an implication to Three weeks later the patient complained be considered. Somigliana et al. confirmed that intense in the right iliac fossa and may be considered a critical process intense tenesmus. The transabdominal involved in the origin of endometriomas and examination revealed a hypoechoic fluid cyst of 15 studied the management of in the x 26 mm in the right ovary, with the ultrasound infertile patient (2). patterns of a hemorrhagic corpus luteum cyst (internally a predominant hypoechogenic pattern The present case shows the transition from a with linear hyperechogenic lines in the absence of hemorrhagic corpus luteum to an endometrioma color flow as assessed by Doppler technology), as demonstrated by ultrasound images and by with the classic “ring of fire” of the corpus histology. High Doppler resistive indices of the luteum. Resistive indices were surprisingly high cyst flow suggest an eventual explanation for (RI 0.78 and PI 1.84) comparing with the the persistence and transformation of the normal trend of a corpus luteum vasculature hemorrhagic corpus luteum to endometrioma. indices. ARC Journal of Gynecology and Obstetrics Page |11

It May Happen: Endometrioma from Hemorrhagic Corpus Luteum

Although the patient did not present menses luteal phase there is a process of structural afterwards, a control was performed 4 weeks luteolysis in the corpus luteum mediated by later because of persistent pain and tenesmus blood vessel regression (4). and at that time the cyst was found to be bigger In case of endometriotic cysts, resistive indices (46 x 55 mm) with respect to the first are shown to be higher than those in the corpus examination, and classical changes as expected luteum or corpus luteum cysts with RI ranging in hemorraghic corpus luteym were not from 0.56 to 0.67 in different study groups (5). observed (persistence of hyperechogenic lines and ovarian resistances persisting high). The possible change of a hemorragic corpus luteum cyst in an endometrioma, should be Menses returned after 8 weeks and another taken in mind, if not disappearing spontaneously examination was performed in the 5th day and in time and presenting persistent high ovarian the cyst presented dimensions somewhat resistances. reduced (42 x 62 mm), the ultrasound pattern was similar to all other ultrasound examinations Doppler ovarían resistances evaluation of the and ovarían resistances kept high. hemorragic corpus luteum cysts is suggested in order to predict the successive monitoring, Due to a continuous pelvic pain with no relief to because if high, may be susceptible to a antinflammatory oral therapy, the patient probable transformation in endometriomas. underwent a laparoscopy. A chocolate cyst was found in the right ovary and it was removed. REFERENCES Histology showed and confirmed the presence [1] Nisolle M, Donnez J. Peritoneal endometriosis, of an endometrioma. ovarian endometriosis, and adenomyotic 3. CONCLUSION nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997; 68: 585– Vercellini et al (3) demonstrated by serial 96. ultrasonographic scans, a direct transition form a [2] Somigliana E, Vigano P, Benaglia L, et al. hemorrhagic cystic corpus luteum to an Management of Endometriosis in the Infertile endometriotic cyst. They concluded that Patient. Semin Reprod Med. 2017; 35: 31-37. bleeding from a corpus luteum seems to be a [3] Vercellini P, Somigliana E, Vigano P, et al. critical event in the development of Blood on the tracks from corpora lutea to endometriomas. endometriomas. BJOG. 2009; 116: 366-71. Vascular resistance within the corpus luteum is [4] Sugino N, Matsuoka A, Taniguchi K, et al: modeled as a relatively invariable parameter, Angiogenesis in the human corpus luteum. Reprod Med Biol. 2008, 7: 91-103 fixed at a low level by the morphological characteristics of the luteal vasculature. Studies [5] Kupesic S, Kurjak A. The assessment of normal and abnormal luteal function by transvaginal have shown that angiogenesis actively occurs color Doppler sonography. Eur J Obstet during the early luteal phase and is completed Gynecol Reprod Biol. 1997; 72: 83-7. by the mid-luteal phase. Conversely, in the late

Citation: Juan Piazze, Ettore Palma, Francesco Recchia, Cristina Galligani, Silvio Rea. It May Happen: Endometrioma from Hemorrhagic Corpus Luteum. ARC Journal of Gynecology and Obstetrics 2017; 2(3):11-12. DOI: dx.doi.org/10.20431/ 2456-0561.0203003 Copyright: © 2017 Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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