Background: Preoperative imaging assessment is essential to draw an accurate map of endometriotic lesions. Knowledge of the extension and severity of disease is paramount for the surgical team in order to plan the type of surgery, complete the operating team and properly inform the patient with details of the risks. Material and Method: Transvaginal ultrasound is the first-line imaging technique for ovarian and deep infiltrating endometriosis, but the accuracy of the diagnosis is proportional with the experience of the operator. Respecting the four steps of ultrasound evaluation technique decreases the probability of misdiagnosis. Step 1 include evaluation of the uterus and adnexa, step 2 - evaluation of “soft marker”, step 3 - assessment of the Pouch of Douglas using “sliding sign” and step 4 - assessment of anterior pelvic compartment (urinary bladder, uterovesical region and ureters) and posterior pelvic compartment (rectovaginal septum, posterior vaginal fornix, uterosacral ligaments, rectum and sigmoid). MRI is performed as an additional examination in complex cases prior to surgery, in symptomatic patients with negative or equivocal ultrasound findings and it can be useful for diagnosis of multiple sites of deep infiltrating endometriosis. Results: Important information from recent guidelines and relevant literature are highlighted. Ovarian and deep endometriosis diagnosed by ultrasound scan and MRI imaging - case series (personal experience) will be commented. Conclusion: As with cancer pathology, the success of treatment depends on complete excision of the endometriotic lesions. Rigorous imaging investigation avoids „the tip of the iceberg” mirage and enhances the quality of medical care.

Endometriosis became a public health problem both due to the increasing number of affected patients and the severe quality of life impairment. Cervical endometriosis is defi ned as the presence of endometrial glands and stroma at cervical level. Primary and secondary cervical endometriosis are two separates entities that require distinct management. Symptomatic cases diagnosed with primary cervical endometriosis have indication for ERAD while patients with secondary cervical endometriosis should be referred to a specialized center because the surgical treatment may imply a high degree of diffi culty. We present a 24-year-old woman with no history of cervical interventions, first diagnosed with cervical displasia and referred to our center for a second opinion. Secondary cervical endometriosis and vaginal endometriotic nodule were diagnosed. Following the general consensus for the benefits of surgery for endometriosis associated with pelvic pain, the patient was considered a candidate for laparoscopic surgery. Complete resection of the endometriotic tissue including the vaginal nodule with laparoscopic suture of the vaginal wall was realized. Laparoscopic surgery for endometriosis is proven to improve the patients’ quality of life, diminishing the symptoms and increases the likelihood of obtaining a spontaneous pregnancy. The presented case illustrates the benefi ts of surgery for secondary cervical endometriosis with marker improvement in quality of life proven with EHP-30 up to 2 years after surgery.