A malignant mimicker: Endometriosis presenting as a large solid–cystic pelvic mass with lymphadenopathy and distal ureteral invasion

Abstract

Endometriosis presents with various imaging features. The most common site of endometriosis is the ovary, followed by the pelvic peritoneum. Less frequently affected sites include the deep subperitoneal tissues, the gastrointestinal tract, the urinary bladder, the thorax, and subcutaneous tissues.

We present a rare case of endometriosis with atypical symptoms and radiographic features. The patient initially presented with hematuria. Evaluation revealed a pelvic mass with skip lesions extending to the distal ureter, mimicking malignancy. Focal endometriosis in the right external iliac region resembled nodal metastasis. These findings led clinicians and radiologists to suspect a malignant process. Consequently, endometriosis should be considered in the differential diagnosis under specific circumstances.