2026 Clinician Corner - Polypoid endometriosis with endometrioid intraepithelial neoplasia mimicking malignancy: a rare case of a postmenopausal pelvic mass

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Abstract 

Polypoid endometriosis is a rare variant characterized by mass-forming endometriosis, often mimicking malignancy. This report describes the case of a postmenopausal woman who presented with an incidental complex adnexal mass and elevated tumor markers. She underwent bilateral salpingo-oophorectomy and mass removal. Frozen section suggested endometriosis with possible serous borderline tumor, prompting staging. Final pathology revealed polypoid endometriosis with areas of endometrioid intraepithelial neoplasia. Polypoid endometriosis may present as a postmenopausal pelvic mass with elevated tumor markers and can contain endometrioid intraepithelial neoplasia.

Keywords:  Endometrioid intraepithelial neoplasia; ovarian cancer mimic; pelvic mass; polypoid endometriosis; postmenopausal mass

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Faculty credentials/disclosure 

Austin T. Jones, MDa, Charles M. Quick, MDb, and Monique A. Spillman, MD, PhDc

aDepartment of Obstetrics and Gynecology, St. David’s Healthcare, Austin, Texas, USA

bDepartment of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

cDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Corresponding author: Austin T. Jones, MD, 4310 James Casey St., Building 3, Austin, TX 78745 (e-mail: [email protected])

ORCID Austin T Jones: https://orcid.org/0009-0008-4733-1946

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on September 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize polypoid endometriosis as a rare, mass-forming endometriosis variant that can mimic gynecologic malignancy in peri- and postmenopausal patients and explain why definitive diagnosis requires permanent histopathology.
  • Interpret elevations in CA-125 and CA 19-9 in the setting of a complex pelvic mass as supportive but nonspecific findings and describe how serial tumor marker trends may inform individualized postoperative surveillance when baseline markers are elevated.
  • Identify the clinical significance of endometrioid intraepithelial neoplasia arising within polypoid endometriosis, including implications for postoperative estrogen exposure and surveillance planning.

Key Points 

  • Polypoid endometriosis is a rare, mass-forming variant that can closely mimic gynecologic malignancy in peri- and postmenopausal patients.
  • Definitive diagnosis of polypoid endometriosis requires permanent histopathology.
  • Polypoid endometriosis may present with elevated CA-125 and CA 19-9.
  • Polypoid endometriosis can harbor endometrioid intraepithelial neoplasia, which carries premalignant implications that influences postoperative estrogen management and surveillance.

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Course summary

Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
09/01/2026
Course expires: 
09/01/2027
Cost:
$25.00

Austin T. Jones, MDa, Charles M. Quick, MDb, and Monique A. Spillman, MD, PhDc

aDepartment of Obstetrics and Gynecology, St. David’s Healthcare, Austin, Texas, USA

bDepartment of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

cDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Corresponding author: Austin T. Jones, MD, 4310 James Casey St., Building 3, Austin, TX 78745 (e-mail: [email protected])

ORCID Austin T Jones: https://orcid.org/0009-0008-4733-1946

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report.

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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