E1150. What's New in Endometriosis Pathogenesis, Imaging Findings, and Management? 2021 Update
  1. Amir Anvari; UT Health San Antonio
  2. Luis Garza; UT Health San Antonio
  3. Nasser Jamal Issa; UT Health San Antonio
  4. Priyanka Jha; UCSF
  5. Srinivasa Prasad; MD Anderson Cancer Center
  6. Venkat Katabathina; UT Health San Antonio
Endometriosis is an estrogen-dependent inflammatory disorder of reproductive age women and causes infertility and chronic pelvic pain. Evolving knowledge regarding origin and pathogenesis of endometriosis has opened new avenues for the development of targeted therapies.

Educational Goals / Teaching Points
Review current updates on genetics and pathogenesis of endometriosis and associated benign and malignant conditions. Describe imaging features of different types of endometriosis and their complications. Discuss evolving surgical and medical treatment options for endometriosis with special emphasis on the role of imaging in the management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Classification: Ovarian endometriomas (OE), superficial endometriosis (SE) and deep infiltrating endometriosis (DIE). Pathogenesis: Retrograde menstruation, endometrial / bone marrow-derived stem cell theory and unified theory. Genetics: KRAS, ARIDIA, PIK3CA, PPP2R1A and epigenetic/micro RNA alterations. Pathology Findings: Gross and Histopathology. Imaging Techniques: Fluoroscopy, US, MDCT, MRI and FDG PET-CT. Imaging Findings of different types of endometriosis including OEs, SE and DIE; stromal, polypoid, atypical, and mesothelial hyperplasia associated with endometriosis. Associated conditions: Adenomyosis, endometrial polyps, leiomyomas, ovarian serous/mucinous cysts, extra-ovarian endometriomas and dermoid. Malignancies: Clear cell, endometroid, seromucinous ovarian tumors. Adenosarcoma, low-grade endometrial stromal sarcoma and carcinosarcoma. Management: Surgical and medical treatments; considerations for fertility preservation. Novel targeted therapies.

A unified theory combining the existing retrograde menstruation concept and the novel stem cell theory was described recently that can explain varied imaging findings. Imaging plays a pivotal role in the timely diagnosis of endometriosis that can prevent malignancies and other complications.