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Insights into Imaging
Fig. 33 | Insights into Imaging

Fig. 33

From: Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation

Fig. 33

Deep pelvic endometriosis in a 37-year-old woman with previous surgery for a perforated sigmoid colon adenocarcinoma. a, b Axial CT images in the portal phase show bilateral cystic ovarian lesions (white arrows) and occupation of the pouch of Douglas by an ill-defined soft tissue lesion (yellow arrows), which raised the suspicion of pelvic recurrence. c Axial T2-weighted MR image shows a hypointense fibrotic endometriotic implant in the pouch of Douglas, which infiltrates and retracts the posterior uterine wall, the adnexa and the anterior rectal wall (red arrows). d Axial fat-suppressed T1-weighted MR image shows small hemorrhagic foci inside the fibrotic implant (red oval). An exploratory laparotomy was performed to resect the deep endometriotic implants and rule out malignancy. e, f H&E stain photomicrographs showed endometrial tissue with hemorrhagic foci and histiocytes infiltrating the mesosalpinx (black circle), confirming the diagnosis of deep pelvic endometriosis

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