Multiple Polypoid Endometriosis-A Rare Complication Following Withdrawal of Gonadotrophin Releasing Hormone (GnRH) Agonist for Severe Endometriosis: A Case Report

EDITORIAL COMMENT: We accepted this case report for publication because the condition of multiple pelvic polypoid lesions seems previously unreported, is an interesting clinical puzzle, and may be a rare complication of hormone therapy. Sections of these polyps have been reviewed by very senior pathologists one of whom confirmed that 'they consist of an endometrial glandular component, a mesenchymal component and large numbers of blood vessels. One possibility is that simply these are very much altered foci of endometriosis-though I find it difficult to believe that these lesions are due to hormonal therapy for if they were I am sure such lesions would have been recorded before now'. Can any reader provide further relevant information?
Summary: A 30-year-old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.