Date: Mon, 6 May 2013 17:50:37 -0400 on listserv AAGL From: Philippe R Koninckx and Drssa Anastasia Ussia <Gary_Frishman@BROWN.EDU>
Subject: Endometriomas

1. Some asymptomatic endometriomas are a cystic corpus luteum, some of which may persist for a long time. The longest we have seen is six months even under oral contraception.

2. Cystic ovarian endometriomas turning malignant is extremely rare and to the best of our knowledge the evidence is scanty, limited to case reports. This anyway is not an indication for surgery.

3. A full discussion whether a history of cystic ovarian endometriosis increases the later risk of ovarian cancer is beyond the scope of this short answer (would require a full debate at AAGL). Fundamentally there are 2 issues. Fist any association can by definition not prove a cause and effect. There can be a bias in inclusion (how solid was the previous
diagnosis of (cystic ovarian) endometriosis ), whereas all other endometriosis associated factors should be considered such as infertility, infertility treatment, gonadotropin therapy, laparoscopy, surgery, chronic pain, medical treatment of endometriosis etc. Model building with logistic can help but to distinguish between independent and dependent variables. Although the jury is still out, I personally do not believe that this association is true and certainly not an indication for surgery.

Prof em Philippe R. Koninckx and Drssa Anastasia Ussia
Gruppo Italo Belga, Leuven and Rome

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