MR Imaging Findings of Extraovarian Endocervical Mucinous Borderline Tumors Arising from Pelvic Endometriosis
A 35-year-old woman (gravida 0, para 0, abortus 0) presented with dysmenorrhea and vague lower abdominal pain. Her past history was unremarkable. At the time of presentation, she was having regular menstrual cycles. She was afebrile and her abdomen was soft and flat without any tender points. Laboratory data were normal except for the elevated level of CA 125 (44 U/mL; normal 0-35 U/mL) and CA 19-9 (271 U/mL; normal 0-37 U/mL).\nMRI showed an elongated tubular cystic lesion with high signal intensity on both T1- and T2-weighted images in the left adnexa, which was diagnosed as hematosalpinx. An axial T2-weighted image showed a stellate low signal intensity lesion with obliteration of the cul-de-sac, suggestive of deep infiltrating endometriosis. The uterus was diffusely enlarged with focal adenomyosis and an intraumral myoma in the posterior wall. Two small cystic lesions with mural nodules were present in the cul-de-sac along the posterior margin of the uterus. These cystic components showed high signal intensity similar to that of urine on T2-weighted images as well as high signal intensity that was slightly higher than that of myometrium on fat-suppressed T1-weighted images. Peripheral nodular enhancement was seen in the cystic lesions on gadolinium-enhanced T1-weighted images, raising the possibility of malignancy (). Mural nodules were not definitely seen in the left fallopian tube.\nSurgery revealed severe pelvic endometriosis involving bilateral ovaries, the cul-de-sac, rectosigmoid colon and left hydrosalpinx. On histopathologic examination, cul-de-sac masses and the left fallopian tube showed mucin-filled cysts and branching papillary projections. The papillae were lined by endocervical type mucinous cells. Microscopic examination revealed a gradual transition from the epitheliums of endometeriosis to mucinous tumor cells. The pathologic diagnosis was confirmed as endocervical mucinous boderline tumor involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis.