This video shows a Large Ovarian Endometrioma, also known as a chocolate cyst or Endometriotic cyst.
Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They're also called ovarian endometriomas. The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A chocolate cyst can affect one or both ovaries and may occur in multiples or singularly.
A hemorrhagic ovarian cyst (HOC) is an adnexal mass formed because of the occurrence of bleeding into a follicular or corpus luteum cyst. Hemorrhagic cysts are commonly seen in clinical practice because hemorrhaging into a cyst is usually painful, triggering the patient to consult her physician.
Endometrioma is distinguished from other types of ovarian cysts by a somewhat grainy and not completely anechoic content.
Endometriosis causes chocolate cysts. Endometrial tissue lines the uterus, and endometriosis causes this tissue to grow outside the uterus as well. Endometrial tissue can attach to the ovaries, fallopian tubes, and nearby organs, such as the bladder.
An ovarian cyst is a fluid-filled sac that develops in or on the ovary and usually disappears after ovulation. Most ovarian cysts don't cause any problems and go away on their own.
Chocolate cysts are common in women with endometriosis. Symptoms can often be managed with medication. In some cases, the cysts will need to be removed. According to a study, about 30 percent of surgically removed chocolate cysts will return, especially if they were large or medically treated.
If ovulation occurs less often, or if the eggs are less healthy, the chances of pregnancy decrease. It is important to remember that endometriomas do not inevitably cause infertility. In fact, some women with advanced endometriosis and chocolate cysts easily get pregnant.
Endometriomas may be considered the most serious threat to a woman's reproductive potential, except for cancerous tumors of the reproductive tract. These cysts can represent a medical dilemma even while women are receiving fertility treatments such as assisted reproductive technologies (ART).
The appearance of endometriomas can be quite variable. The classical example is a unilocular cyst with acoustic enhancement with diffuse homogeneous ground-glass echoes as a result of hemorrhagic debris. This appearance occurs in 50% of cases.
The characteristic appearance of an endometrioma on sonography is that of a hypoechoic mass containing diffuse low-level internal echoes, the so-called “chocolate cyst.” However, many other appearances have been described, including an anechoic cyst, a solid-appearing mass, and solid elements in a cyst.
Endometrioma is defined as either a unilocular mass with ground glass echogenicity and a color score between 1 and 3 (i.e. no vascularization to moderate vascularization) or a unilocular-solid mass with ground glass echogenicity with a papillary projection, a color score of 1 or 2, and no flow inside.
Scattered vascularity, one feature of adnexal endometriomas, may help to differentiate them from other lesions of dense vascular distribution, such as corpora lutea or ovarian neoplasms.
A general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The presence of small endometriomas (2-4 cm) does not reduce the success of in vitro fertilization (IVF) treatment.
Difference between endometriosis and Endometrioma
Endometriosis is the presence of endometrial glands and tissue outside the uterus. Women with endometriosis may have problems with fertility. Endometrioid cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches. Endometrioma is also referred to as an endometrioid cyst.
They are filled with dark brown endometrial fluid and are sometimes referred to as "chocolate cysts." The presence of endometriomas indicates a more severe stage of endometriosis. Endometriomas can lead to chronic pelvic pain and infertility and often require surgery for treatment.
Endometriosis does not resolve on its own. If you experience pain and other symptoms, these symptoms will remain unless you receive treatment. In some cases, your symptoms may get worse.
Endometriotic cysts (endometriomas) generally occur within the ovaries and are the result of repeated cyclic hemorrhage within a deep implant. They may completely replace normal ovarian tissue. Cyst walls are generally thick and fibrotic and commonly have areas of discoloration and dense fibrous adhesions.
Bilateral homogeneous, hypoechoic cystic lesions were adherent to each other at the midline. The close proximity of both ovaries is known as "Kissing Ovaries".