Surgical Techniques

Endometriomas: Classification and surgical management

Understanding the etiology of endometriomas and implementing a more nuanced classification system can aid in the successful management of this common condition

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Illustration: Kimberly Martens for OBG Management

Endometriomas are called chocolate cysts due to the dark brown color of the fluid they contain. When possible, endometriomas should be aspirated and irrigated prior to cystectomy to avoid seeding the pelvis with spilled endometriotic contents.

Endometriosis, a disorder in which tissue resembling endometrium develops outside the uterine cavity, is a common cause of pelvic pain and infertility, affecting 6% to 10% of women.1 Although endometriosis occurs in almost all organs and anatomic locations, it most often affects the pelvic organs.2 An ovarian endometrioma, an ovarian cystic mass generally consisting of endometrial glands and stroma, is seen in 17% to 44% of women with endometriosis.3 Endometriomas are sometimes called chocolate cysts for the dark brown, thick, and tarry concentrated hemosiderin-laden fluid they contain, but histology shows that not all chocolate cysts have endometriosis within their walls.4 Understanding the etiology of endometriomas and implementing a more nuanced classification system can aid in the successful management of this common condition.

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Etiology

Endometriomas are extensively described in the literature, and their origin is the subject of several theories. In 1921, Sampson noted luteal membrane and ovarian epithelial tissues within endometriomas and was the first to indicate that endometriomas may result from the invasion of functional cysts by endometrial tissue.2,4,5 In 1979, Czernobilsky and Morris6 found endometrial and oviduct-like epithelium in ovarian endometriosis and concluded that ovarian tissue may be a common histologic precursor. Several other authors subsequently have reported finding different types of tissue within ovarian endometriomas, and not all of these chocolate cysts showed histologic evidence of endometriosis.4,7,8

Read about the classification of endometriomas

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