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a medium brown to dark-brown color (同)coffee, deep brown, umber, burnt_umber
a food made from roasted ground cacao beans
a closed sac that develops abnormally in some body structure

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〈U〉〈C〉『チョコレート』;《複数形で》『チョコレート菓子』 / 〈U〉チョコレート飲料 / 〈U〉チョコレート色 / チョコレート製の,チョコレト入りの / チョコレート色の
胞嚢(ほうのう)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/09 08:37:21」(JST)

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An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst of ovary is a condition related to endometriosis.

Pathophysiology[edit]

Endoscopic image of a ruptured chocolate cyst in left ovary.

It is caused by endometriosis,^[1] and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between.

Treatment[edit]

Treatment for endometriosis can be medical or surgical.

Medication[edit]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively (excision and biopsy) established. The goal of directed medical treatment is to achieve an anovulatory state. Typically, this is achieved initially using hormonal contraception. This can also be accomplished with progestational agents (i.e., medroxyprogesterone), danazol, gestrinone, or gonadotropin-releasing hormone agonists (GnRH), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. GnRH can be combined with estrogen and progestogen (add-back therapy) without loss of efficacy but with fewer hypoestrogenic symptoms. These medications are often ineffective in treating endometriomas and any relief is short lived while taking the medications. Hormonal treatment has a large number of sometimes permanent side effects, such as hot flushes, loss of bone mass, deepening of voice, weight gain, and facial hair growth.

Surgery[edit]

Laparoscopic surgical approaches include excision of ovarian adhesions and of endometriomas. Endometriomas frequently require surgical removal and excision is considered to be far superior in terms of permanent removal of the disease and pain relief. Surgery can sometimes have the effect of improving fertility but can have the adverse effect of leading to increases in cycle day 2 or 3 FSH for many patients.^{[citation needed]} Laser surgery and cauterization are considered to be far less effective and only burn the top layer of endometrial tissue, allowing for the endometrioma and endometriosis to grow back quickly. Likewise, endometrioma drainage or sclerotherapy are somewhat controversial technique for removing endometriomas with varied degrees of success. Conservative surgery can be performed to preserve fertility in younger patients but as earlier stated can have the effect of raising FSH values and making the ovaries less productive, especially if functional ovarian tissue is removed in the surgical process.^{[citation needed]} Operative laparoscopic surgery can provide pain relief and improved fertility. Radical surgical options could include singular or bilateral oophorectomy. ^[2]^[3]

References[edit]

^ "Female Genital Pathology". Retrieved 2009-05-12.
^ "What You Need To Know About Ovarian Cysts, Common Types". HealthCentral.
^ Endometrioma/Endometriosis at eMedicine

UpToDate Contents

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1. 卵巣子宮内膜腫の診断および管理 diagnosis and management of ovarian endometriomas
2. 子宮内膜症の病因、臨床的特徴、および診断 pathogenesis clinical features and diagnosis of endometriosis
3. 子宮内膜症の治療の概要 overview of the treatment of endometriosis
4. 付属器腫瘤の鑑別診断 differential diagnosis of the adnexal mass
5. 子宮内膜症を有する女性における不妊症の病因および治療 pathogenesis and treatment of infertility in women with endometriosis

English Journal

Mining medical data: a case study of endometriosis.

Wang YF, Chang MY, Chiang RD, Hwang LJ, Lee CM, Wang YH.SourceInstitute of Information and Decision Sciences, National Taipei College of Business, Taipei, Taiwan, Republic of China, yfwang_tw@webmail.ntcb.edu.tw.
Journal of medical systems.J Med Syst.2013 Apr;37(2):9899. doi: 10.1007/s10916-012-9899-y. Epub 2013 Jan 17.
Ultrasound guided aspiration of ovarian endometrioma had been tried as an alternative therapeutic modality in patients whose desire to avoid surgery or surgical approach is contraindicated since 1991. Cyst puncture can reduce tumor volume and destruct the cyst wall, alleviate sticking circumstances
PMID 23321969

Added health benefits of the levonorgestrel contraceptive intrauterine system and other hormonal contraceptive delivery systems.

Fraser IS.SourceDepartment of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Camperdown, NSW 2006, Australia. Electronic address: ian.fraser@sydney.edu.au.
Contraception.Contraception.2013 Mar;87(3):273-9. doi: 10.1016/j.contraception.2012.08.039. Epub 2012 Oct 4.
BACKGROUND: It has been recognized for well over half a century that hormonal preparations designed as contraceptives are also capable of offering health benefits through the treatment and prevention of benign gynecological disease and even some systemic conditions. Increasing attention is now being
PMID 23040129