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Photograph of the left ovary and the adjacent left fallopian tube with thick brown chocolate syrup-like fluid leaking from an ovarian cyst. This is a classic appearance for an ovarian endometrioma (commonly referred to as a “chocolate cyst”).
Surgically, one needs to unroof the cyst and completely remove (or destroy) the lining of the cyst (containing the endometriotic lesions) to minimize recurrence. If the cyst is simply aspirated or one makes a small window in the wall of the cyst (fenestrated) the recurrence rates are as high as 90%. If the entire cyst wall is removed or destroyed, the recurrence rates are much lower (possibly as low as 10%).
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