Decidualized Ovarian Endometriomas in Pregnancy: Proposal of a Predictable Ultrasound Evolution Pattern.

Authors

Maria Margarida Ribeiro, Margarida Fernandes, Sofia Moura, Susana Saraiva, Sara Sereno, Catarina Maia, Mariana Pimenta

Published in

Journal of gynecology obstetrics and human reproduction. Pages 103250. Aug 08, 2026. Epub Aug 08, 2026.

Abstract

Decidualized ovarian endometriomas are benign lesions that can closely mimic ovarian malignancy on ultrasound. Correctly identifying them is crucial to avoid unnecessary interventions and associated adverse fetal-maternal outcomes. A systematic review of the literature was performed to identify common sonographic patterns and key diagnostic features reported across gestation. Thirteen studies comprising 35 cases were included. Ultrasound appearance evolved similarly: simple cysts with minimal vascularity in early pregnancy; rounded, vascularized papillary projections within cystic lesions during the second trimester; and solid-appearing, highly vascularized masses in the third trimester. Most cases were managed surgically. Expectant management was associated with postpartum regression and no reported complications. No malignant transformations were identified. Recognizing these imaging patterns facilitates accurate diagnosis, reduces unnecessary surgical procedures during pregnancy, and supports safe expectant management. Awareness of the dynamic, gestational evolution of decidualized endometriomas is essential for physicians involved in prenatal care.

PMID:
42570719
Bibliographic data and abstract were imported from PubMed on 09 Aug 2026.

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