Typical endometriosis or gunshot lesions are 1 to 2 cm or larger black puckered endometriosis in a white sclerotic area, in the pelvis and on the diaphragm. 50% are painful up to 3cm distance 

Cystic ovarian endometriosis

Cystic ovarian endometriosis or chocolate cysts the ovary,  are  mostly 3-6 cm in diameter but can be much larger or smaller.
These cyst usually are fixed to the pelvic wall and other organs of the pelvis.
Stripping of the wall is the preferred technique since less recurrences. However, more recently superficial treatment was reconsidered see our recent publication  Medical therapy is ineffective
A cystic corpus luteum can mimic a cystic ovarian endometriosis

Deep endometriosis : solid tumors

Endometriosis can present as solid tumours up to 5 by 6 cm in diameter most frequently in the pouch of Douglas.
From the left picture it is obvious that this endometriosis is in close proximity of the vaginal wall, causing dyspareunia, and of the rectum, causing pain during bowel movement.
Other localizations are the sigmoid (not detectable clinically and easily missed during laparoscopy (except when the surgeon has great experience)and between the uterus and the bladder (hence bladder irritation and pain.

Deep endometriosis of the rectovaginal septum

rectoscopy is generally normal ; only the larger ones are felt

Deep endo of the vesico-uterine fold  and the ureter

Deep endo of the sigmoid

is easily missed during laparoscopy and is generally underestimated ; it is  difficult surgery.

Fot this reason we think that a contrast enema remains the only reliable method to judge occlusion

Adenomyosis

The definition is clear: endometrial stroma and glands in the myometrium. The prevalence varies between 30 and 70% according to the number of microscopical slides investigated .
There are 3 types of adenomyosis

• thickening of the junctional zone
• diffuse adenomyosis
• nodular adenomyosis

Adenomyosis is a cause of pain and infertility

The Ovarian remnant Syndrome : endometriosis

The ovarian remnant syndrome is fortunately rare. The literature is almost empty and I have not seen more than ten over the last 15 years. Diagnosis and surgery always are difficult.
The ovarian remnant syndrome should be thought of when a women following hysterectomy and ovariectomy has severe chronic pain, whereas at ultrasound (or other imaging techniques, a multi-cystic ovary is found with a suspicion of endometriosis). At laparoscopy as depicted below, almost invariably a frozen pelvis with encapsulated ovary is found : at dissection after identification of the ureter, is becomes immediately clear that the ureter is located inside the ovarian mass. Therefore the surgeon should be very experienced.