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Endometriotic Intramyometrial Cyst –A Diagnostic Dilemma


Anand Bhatt, Keeranmayee Mishra and Vishal Chavda*   Pages 1 - 3 ( 3 )


Background: Endometriosis is a pathological state in which the endometrial glands and stroma are originated at sites other than the uterine cavity. Endometriotic cystic lesions are principally positioned in ovaries but infrequently can also be encountered in the myometrium. It is rare manifestation which poses a multitude of differential diagnoses and therapeutic options.

Case study: A 27-year-old female patient walked into a crisis with brutal abdominal pain since 2 days with a medical history of dysmenorrhoea since one and a half year. On examination, the abdomen was flexible with the existence of lower abdominal tenderness. An Ultrasonography revealed a myometrial posterior wall cyst of size 4 x 4 cm with thick wall and spotted internal echoes favoring a differential diagnosis of either an endometriotic cyst or rudimentary horn. Both ovaries were found normal. The patient was taken for laparoscopy in which a bulge was seen on the posterior uterine wall, it was punctured to expose a myometrial cyst with dark chocolate colored fluid collection. The intact cyst was enucleated and sent for histopathology which confirmed the diagnosis of the endometriotic cyst. Upon the literature survey, we found only two such case literature available on the internet which describes a similar pathology.

Conclusion: Endometrioma should be considered as a probable pathology whenever myometrial cysts are encountered. A focused transvaginal examination can be very accommodating as a diagnostic modality to set up proper management. This case should not only make us rethink the etiopathogenesis of endometriosis and debates the credibility of the retrograde menstruation hypothesis but also encourages us to accurately investigate any lesion anywhere in the body which looks like an endometriotic chocolate cyst. In our case, it’s evident that myometrial spot is rare but not impossible. These rare occurrences shall direct us and forward us to diversify our perception of this pathology.


Endometriotic cyst, Myometrial cyst, Chocolate cyst, Chocolate fluid


Department of Obstetrics and Gynecology, Sardar Multispecialty Hospital, Department of obstetrics and Gynecology, DRM Multispecialty Hospital, Department of Pharmacology, Nirma University

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