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1
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Heda S, Scerif M, Parker R, Bedoya-Ronga A. Surgical exploration of primary umbilical and inguinal canal endometriosis: a cutaneous conundrum. BMJ Case Rep 2025; 18:e261800. [PMID: 40032572 DOI: 10.1136/bcr-2024-261800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025] Open
Abstract
Primary cutaneous endometriosis and inguinal endometriosis (IEM) are rare, representing less than 1% and under 0.6% of extragenital and extrapelvic endometriosis, respectively. Co-occurrence in the same patient is exceedingly rare, with a frequency as low as 5 cases per 100 000. This case presents the first instance of a patient simultaneously afflicted with both types. Endometriosis involves the ectopic presence of endometrial tissue, with primary umbilical endometriosis (PUE) localised in the umbilicus without prior surgery, and IEM affecting the inguinal canal. In a nulliparous woman in her early 30s, lacking surgical history, the diagnosis of PUE, IEM and pelvic endometriosis was made following presentation with chronic pelvic pain and a painful umbilical nodule. This report aims to delineate the presentation, diagnosis and surgical management of patients with umbilical and IEM, shedding light on these rare manifestations.
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Affiliation(s)
- Sakshi Heda
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Miski Scerif
- Midlands Metropolitan Endometriosis Centre (MidMEC), Birmingham, UK
| | - Robert Parker
- Midlands Metropolitan Endometriosis Centre (MidMEC), Birmingham, UK
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2
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Mahdavi A, Forouzannia SA, Goudarzi E, Forouzannia SM, Rafiei R, Yousefimoghaddam F, Rafiei N, Padmehr R. Radiofrequency Ablation: A Promising Treatment Method for Abdominal Wall Endometriosis. Cardiovasc Intervent Radiol 2024; 47:1009-1014. [PMID: 38811406 DOI: 10.1007/s00270-024-03755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To evaluate the application of radiofrequency ablation (RFA) as a treatment method for abdominal wall endometriosis (AWE). MATERIALS AND METHODS The characteristics of the AWE lesions in the patients were obtained using ultrasound (US). The patients received general and local anesthesia, and then, AWE lesions were divided into 1 cm3 sections visually, and each of these sections underwent US-guided RFA using the moving shot technique. Follow-up included outpatient appointments, including a US examination 1, 3, and 6 months after the treatment to assess the volume of the lesions. In addition, the level of pain experienced by the patients was measured using a visual analogue scale (VAS) before and the day after the procedure, as well as at each follow-up appointment. RESULTS Ten patients were treated with RFA. The procedural success was achieved in all of the patients. The median volume of the lesions decreased from 7.3 cm3 (IQR = 4.39,23.75) to 2.95 cm3 (IQR = 1.65,9.09) (P = 0.005). All patients reported reduced pain levels, and the median of their VAS score decreased from 9 (IQR = 8,9) to 0 (IQR = 0,1.25) (P = 0.004) at the end of the follow-up period. None of the patients experienced complications related to RFA treatment. CONCLUSION Based on the study's findings, RFA appears to be a promising minimally invasive treatment for AWE. However, larger studies with longer follow-up periods are required for a more comprehensive understanding of its efficacy and safety. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Forouzannia
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Goudarzi
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Romina Rafiei
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Yousefimoghaddam
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Rafiei
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Padmehr
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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3
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Al Shenawi H, Al Shenawi N, Al Mousa NA, Al Abbas LA, Al Zayer NM, Alqhtani MM, Naguib Y. A Typical Presentation of Cesarean Section Scar Endometriosis: A Case Report. Cureus 2023; 15:e49884. [PMID: 38053990 PMCID: PMC10694546 DOI: 10.7759/cureus.49884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/07/2023] Open
Abstract
Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynecological surgeries. Although the symptoms are non-specific and varying, scar endometriosis classically presents with cyclic pain at the site of incision during menstruation. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. Here, we present a case of extragonadal endometriosis at the cesarean section scar. The patient presented with cyclical menstrual pain at the surgical incision. Our aim in this case report is to present the approach to diagnosing such a condition with the associated presentation and histological findings.
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Affiliation(s)
| | | | | | | | | | | | - Yahya Naguib
- Physiology, Arabian Gulf University, Manama, BHR
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Liu Y, Wen W, Qian L, Xu R. Safety and efficacy of microwave ablation for abdominal wall endometriosis: A retrospective study. Front Surg 2023; 10:1100381. [PMID: 37143772 PMCID: PMC10151684 DOI: 10.3389/fsurg.2023.1100381] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives This retrospective study aimed to evaluate the safety and feasibility of ultrasound-guided microwave ablation in the treatment of abdominal wall endometriosis (AWE). Background AWE is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Microwave ablation technology is a promising new thermal ablation technique for treating AWE. Methods This was a retrospective study of nine women with pathologically proven endometriosis of the abdominal wall. All patients were treated with ultrasound-guided microwave ablation. Grey-scale and color Doppler flow ultrasonography, contrast-enhanced ultrasonography, and MRI were used to observe the lesions before and after treatment. The complications, pain relief, AWE lesion volume, and volume reduction rate were recorded 12 months after treatment to evaluate the treatment efficacy. Complications were classified according to the Common Terminology Criteria for Adverse Events and the Society of Interventional Radiology classification system. Results Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with microwave ablation. The average initial nodule volume was 7.11 ± 5.75 cm3, which decreased significantly to 1.85 ± 1.02 cm3 at the 12-month follow-up with a mean volume reduction rate of 68.77 ± 12.50%. Periodic abdominal incision pain disappeared at 1 month after treatment in all nine patients. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. Conclusions Ultrasound-guided microwave ablation is a safe and effective technique for the treatment of AWE, and further study is warranted.
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Yang E, Chen GD, Liao YH. Spontaneous abdominal wall endometriosis: A Case Report and review of the literature. Taiwan J Obstet Gynecol 2023; 62:155-157. [PMID: 36720530 DOI: 10.1016/j.tjog.2022.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE We present a case of spontaneous abdominal wall endometriosis presenting as a painless nodular mass in a woman with no prior history of abdominal surgery. CASE REPORT Abdominal wall endometriosis (AWE) is an uncommon form of endometriosis, usually arising due to a past history of cesarean section or abdominal hysterectomy. However, in rare cases, abdominal wall endometriosis can arise in women with no prior history of abdominal surgery. A 48-year-old woman presented to our obstetrics and gynecology clinic with a painless nodular mass in the right lower quadrant of the abdomen. Abdominal wall ultrasound showed a hypoechoic heterogenous mass under the skin. Wide surgical resection of the mass was conducted and post-operative histopathological report revealed abdominal wall endometriosis. CONCLUSION Spontaneous abdominal wall endometriosis is an uncommon pathologic condition in which accurate diagnosis is difficult. As an increasing number of obstetrical and gynecological procedures are conducted worldwide, surgeons should keep this clinical entity in the differential diagnosis of any abdominal mass in reproductive-aged females regardless of their past surgical history.
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Affiliation(s)
- Evelyn Yang
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yun-Han Liao
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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6
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Poudel D, Acharya K, Dahal S, Adhikari A. A case of scar endometriosis in cesarean scar: A rare case report. Int J Surg Case Rep 2022; 102:107852. [PMID: 36584626 PMCID: PMC9827051 DOI: 10.1016/j.ijscr.2022.107852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Scar endometriosis is a rare entity characterized by presence of functional endometrial tissue in the site of surgical scar. Cesarean section scar is the most common reported site. We herein report a case of cesarean scar endometriosis in a 43-years-old female patient. CASE PRESENTATION A 43 year old female, with history of lower segment cesarean section 8 years back, presented to our center with complains of pain and palpable lump during menstruation, at the site of cesarean scar. On ultrasonography she was said to have some pathology in her previous surgical scar site. On MRI, a soft tissue mass measuring 25 × 35 mm within the subcutaneous tissue of anterior abdominal wall on the left side was seen. She was planned for surgical removal of the tissue. DISCUSSION Scar endometriosis is a rare entity. The iatrogenic implantation of the hormone sensitive endometrial tissue into the edge of the wound during surgery best explains its occurrence. They usually present as a painful nodule in the site of surgical scar that undergoes cyclic variation with the menstrual cycle. Diagnosis can be confirmed by radiography. Treatment options can be medical and surgical, the latter being more effective and the preferred one. CONCLUSION Scar endometriosis often mimics with variety of clinical conditions, so high degree of suspicion is necessary. Efforts should be aimed at minimizing the transfer of endometrial tissue into the subcutaneous area. Gloves replacement prior to closure can avoid the implantation of endometrial tissue into the abdominal wall.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Kshitiz Acharya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
| | | | - Ashmita Adhikari
- Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Dridi D, Buggio L, Donati A, Giola F, Lazzari C, Brambilla M, Chiaffarino F, Barbara G. Clinical Features and Management of Umbilical Endometriosis: A 30 Years' Monocentric Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416754. [PMID: 36554635 PMCID: PMC9779346 DOI: 10.3390/ijerph192416754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5-1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. MATERIAL AND METHODS We retrospectively reviewed all cases of women diagnosed with UE in the period 1990-2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. RESULTS A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. CONCLUSIONS The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.
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Affiliation(s)
- Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Agnese Donati
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Francesca Giola
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Caterina Lazzari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Chiaffarino
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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8
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Balaban M, Cilengir AH, Idilman IS. The ultrasonography, colour Doppler ultrasonography and sonoelastography findings of scar endometriosis in comparison with menstrual phases. J OBSTET GYNAECOL 2022; 42:3218-3223. [PMID: 35959807 DOI: 10.1080/01443615.2022.2109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We aimed to evaluate ultrasonography (US), colour Doppler US (CDUS) and sonoelastography (SEL) findings of histopathologically proven abdominal wall scar endometriosis in comparison with menstrual phases. A total of 24 female patients with scar endometriosis were included. Lesion size, volume, echogenicity, solid/cystic or complex appearance, contour and location on US, vascularisation on CDUS, and elasticity on SEL were recorded in both menstrual and ovulatory phases. Hypoechoic heterogeneous lesions with increased peripheral echogenicity were observed in all lesions. The mean ± standard deviation (SD) volume of the lesions in the menstrual and ovulatory phases of the lesions was 4.36 ± 3.01 cm3 and 4.63 ± 7.61 cm3 (p = .316). The mean ± SD resistive index values on CDUS in the menstrual and ovulatory phases were 0.96 ± 0.09 and 0.97 ± 0.07, respectively (p = .667). The SEL examination demonstrated a hard coding pattern in all cases with no statistically significant difference between menstrual and ovulatory phases (p = .176). We found no significant difference in terms of US, CDUS and SEL findings of scar endometriosis in comparison with menstrual phases which suggests there is no need to evaluate the patient in a specific menstrual phase.Impact StatementWhat is already known on this subject? Scar endometriosis is the endometriosis located at the abdominal wall around the scar area with a very rare incidence. The typical sonographic findings of scar endometriosis are a hypoechoic solid mass with irregular contours. High resistive index on colour Doppler ultrasonography (CDUS) and hard coding pattern on sonoelastography (SEL) are seen in the lesion.What do the results of this study add? This is the first study that evaluates sonographic features of scar endometriosis lesions in the menstrual phase. We found that scar endometriosis lesions did not have a significant difference in terms of B-mode US, CDUS and SEL in menstrual and ovulatory phases.What are the implications of these findings for clinical practice and/or further research? Our findings suggest that there is no need to evaluate the patient in a specific menstrual phase.
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Affiliation(s)
- Mehtap Balaban
- Department of Radiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Ilkay S Idilman
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Dridi D, Chiaffarino F, Parazzini F, Donati A, Buggio L, Brambilla M, Croci GA, Vercellini P. Umbilical Endometriosis: A Systematic Literature Review and Pathogenic Theory Proposal. J Clin Med 2022; 11:995. [PMID: 35207266 PMCID: PMC8879338 DOI: 10.3390/jcm11040995] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
Umbilical endometriosis represents 30-40% of abdominal wall endometriosis and around 0.5-1.0% of all cases of endometriosis. The aim of this systematic review is to revisit the epidemiology, signs, and symptoms and to formulate a pathogenic theory based on literature data. We performed a systematic literature review using the PubMed and Embase databases from 1 January 1950 to 7 February 2021, according to the PRISMA guidelines. The review was registered at PROSPERO (CRD42021239670). Studies were selected if they reported original data on umbilical endometriosis nodule defined at histopathological examination and described as the presence of endometrial glands and/or stromal cells in the connective tissue. A total of 11 studies (10 retrospective and one prospective), and 14 case series were included in the present review. Overall, 232 umbilical endometriosis cases were reported, with the number per study ranging from 1 to 96. Umbilical endometriosis was observed in 76 (20.9%; 95% CI 17.1-25.4) of the women included in studies reporting information on the total number of cases of abdominal wall endometriosis. Umbilical endometriosis was considered a primary form in 68.4% (158/231, 95% CI 62.1-74.1) of cases. A history of endometriosis and previous abdominal surgery were reported in 37.9% (25/66, 95% CI 27.2-49.9) and 31.0% (72/232, 95% CI 25.4-37.3) of cases, respectively. Pain was described in 83% of the women (137/165, 95% CI 76.6-88.0), followed by catamenial symptoms in 83.5% (142/170, 95% CI, 77.2-88.4) and bleeding in 50.9% (89/175, 95% CI 43.5-58.2). In the 148 women followed for a period ranging from three to 92.5 months, seven (4.7%, 95% CI 2.3-9.4) recurrences were observed. The results of this analysis show that umbilical endometriosis represents about 20% of all the abdominal wall endometriotic lesions and that over two thirds of cases are primary umbilical endometriosis forms. Pain and catamenial symptoms are the most common complaints that suggest the diagnosis. Primary umbilical endometriosis may originate from implantation of regurgitated endometrial cells conveyed by the clockwise peritoneal circulation up to the right hemidiaphragm and funneled toward the umbilicus by the falciform and round liver ligaments.
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Affiliation(s)
- Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.D.); (L.B.); (P.V.)
| | - Francesca Chiaffarino
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.D.); (L.B.); (P.V.)
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Agnese Donati
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.D.); (L.B.); (P.V.)
| | - Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.D.); (L.B.); (P.V.)
| | - Massimiliano Brambilla
- Plastic Surgery Service, Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giorgio Alberto Croci
- Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.D.); (L.B.); (P.V.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
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Kido A, Himoto Y, Moribata Y, Kurata Y, Nakamoto Y. MRI in the Diagnosis of Endometriosis and Related Diseases. Korean J Radiol 2022; 23:426-445. [PMID: 35289148 PMCID: PMC8961012 DOI: 10.3348/kjr.2021.0405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis.
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Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
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11
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Li SH, Sun HZ, Li WH, Wang SZ. Inguinal endometriosis: Ten case reports and review of literature. World J Clin Cases 2021; 9:11406-11418. [PMID: 35071572 PMCID: PMC8717526 DOI: 10.12998/wjcc.v9.i36.11406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To describe the characteristics, diagnosis and surgical treatment of inguinal endometriosis (IEM). CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019. Relevant features, symptoms, images, surgical treatment, hormonal therapy and follow-up were collected and discussed. A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side (9/11); five patients had symptoms related to the menstrual cycle, and only 3 patients were clearly diagnosed before surgery. Ultrasonography was of little assistance in confirming the diagnosis, but magnetic resonance imaging showed specific, high-intensity patterns. Anatomically, most of the IEM lesions were located in the extraperitoneal ligament (10/11); nine patients had inguinal hernias (IH), five had concurrent or prior pelvic endometriosis, and four had infertility. The clinical results from extensive resection were satisfactory. CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery. A right IH may contribute to the formation of right-sided IEM, and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.
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Affiliation(s)
- Shu-Hong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Heng-Zi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei-Hua Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Shu-Zhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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12
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Varshney B, Bharti JN, Satyendra BT, Singh P. Diagnosis of scar endometriosis on aspiration cytology and cellblock: Myth or reality. Diagn Cytopathol 2021; 50:E92-E94. [PMID: 34787957 DOI: 10.1002/dc.24907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/07/2022]
Abstract
Endometriosis is defined as the presence of endometrial tissue outside the uterus. It can occur both in the pelvic and extra pelvic regions. Abdominal scar endometriosis is a rare type of extra pelvic endometriosis that occurs after surgery involving the uterus. In the post-cesarean section, the development of scar endometriosis is a rare event and the diagnosis of scar endometriosis is usually confirmed after surgical excision and histopathological examination. We present a case of an abdominal lump in a 26-year-old female with a myriad of clinical differential diagnoses, which was rendered a confirmed diagnosis of scar endometriosis with the help of fine-needle aspiration cytology and cell block aided with immunohistochemistry.
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Affiliation(s)
- Bharti Varshney
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jyotsna Naresh Bharti
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Cărăuleanu A, Popovici RM, Costea CF, Mogoş RA, Scripcariu DV, Florea ID, Cheaito A, Tănase AE, Haba RM, Grigore M. Abdominal wall endometriosis versus desmoid tumor - a challenging differential diagnosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:45-50. [PMID: 32747894 PMCID: PMC7728103 DOI: 10.47162/rjme.61.1.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: Abdominal wall endometriosis (AWE) in young women, with previous gynecological abdominal surgery, is the first condition considered by many practitioners when a tumor in the region of the scar appears. AWE seems to be caused by an iatrogenic transfer of endometrial cells at the level of the scar. The onset of the disease may be late in many cases. Despite the fact that the disease could be totally asymptomatic, there are certain risk factors that can be identified during the anamnesis, such as: heredity, menarche at the age of >14 years, menstrual cycle <27 days, delayed menopause, excessive alcohol and caffeine consumption. Suggestive signs include cyclic or continuous abdominal pain caused by a palpable abdominal wall mass with a maximum tenderness in the region of the surgical scar. The differential diagnosis is complex and rare entities like desmoid tumors (DTs) must be taken into consideration. Desmoid tumor, or the so-called aggressive fibromatosis (AF), is a rare fibroblastic proliferation. This tumor can develop in any muscular aponeurotic structure of the body and is considered benign but with a high recurrence rate. DTs can cause local infiltration, subsequently producing certain levels of deformity and potential obstruction of vital structures and organs. The differential diagnosis is challenging in this situations, the imagery exams are useful, especially in detecting the precise location of the tumor. The histological examination of the tumor can state the final and precise diagnosis.
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Affiliation(s)
- Alexandru Cărăuleanu
- Department of Ophthalmology, Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review. Diagnostics (Basel) 2021; 11:diagnostics11040609. [PMID: 33805519 PMCID: PMC8065386 DOI: 10.3390/diagnostics11040609] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a debilitating disease characterized by endometrial glands and stroma outside the endometrial cavity. Abdominal wall endometriosis (AWE) indicates the presence of ectopic endometrium between the peritoneum and the skin, including subcutaneous adipose tissue and muscle layers, often following obstetric and gynecological surgical procedures. AWE is a not infrequent gynecological surgical complication, due to the increasing number of cesarean sections worldwide. In this pictorial review, we discuss the importance of medical history and physical examination, including the main ultrasound features in the diagnosis of AWE.
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Reategui C, Grubbs D. Abdominal wall endometriomas. Should the approach vary based on its relationship to the fascia? A case report and review of the literature. Int J Surg Case Rep 2020; 78:62-66. [PMID: 33310473 PMCID: PMC7736765 DOI: 10.1016/j.ijscr.2020.11.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 12/29/2022] Open
Abstract
Abdominal wall endometriomas are rare but not uncommon. Needle biopsy should be attempted before excision to rule out malignancy. Malignant degeneration should always be considered in abdominal wall endometriomas. Abdominal wall endometriomas involving significant muscle and fascia should be considered for nonsurgical treatment. Introduction Abdominal wall endometrioma (AWE) is a rare encountered condition with a prevalence of 1–2%. Multiple diagnostic and treatment modalities are available; however, no clear guidelines exist. On occasions muscle and fascia excision might be necessary to achieve a clear margin. To avoid mesh complications, we believe the treatment should depend on tumor location in relation to the abdominal wall fascia. As far as we know this approach has not been previously discussed. Presentation A 29-year old female with a surgical history of 3 C-sections presented to us with 6 months of cyclical abdominal pain in the left lower quadrant. Imaging studies confirmed the presence of a mass overlying the left lower rectus abdominis muscle. After imaging studies, the mass was surgically excised. Pathology confirmed a benign endometrioma. Discussion Unfortunately, the surgical literature has not established a consensus on the best approach for diagnosis and management of this condition. The purpose of this report is to not only to present another case of this rare phenomenon, but to address the need for guidelines and review the current diagnostic and treatment available options. We also attempt to increase the awareness of this condition, it’s unlikely malignant degeneration and potential morbidity of surgical excision. Conclusion Surgical excision remains the standard of care for AWEs. In those patients where the fascia and muscle must be excised, we recommend less invasive modalities to avoid mesh complications. The need for guidelines remains.
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Affiliation(s)
- Cesar Reategui
- Department of Surgery, Missouri Delta Medical Center, Sikeston, MO, USA.
| | - Derek Grubbs
- Department of Surgery, Missouri Delta Medical Center, Sikeston, MO, USA
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Ojong O, Susa J, Weiss E. A solitary brown nodule on the umbilicus. JAAD Case Rep 2020; 6:1024-1026. [PMID: 32995436 PMCID: PMC7508900 DOI: 10.1016/j.jdcr.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oben Ojong
- Dermatology Residency, Larkin Community Hospital Palm Springs, Hialeah, Florida
- Correspondence to: Oben Ojong, DO, 951 Brickell Ave, apt 1211, Miami, FL 33131.
| | - Joseph Susa
- Aurora Diagnostics Inc/Global Pathology Laboratories, Miami, Florida
| | - Eduardo Weiss
- Hollywood Dermatology and Cosmetic Specialists, Hollywood, Florida
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Li J, Jiang H, Liang Y, Yao S, Zhu Q, Chen S. Multidisciplinary treatment of abdominal wall endometriosis: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 250:9-16. [DOI: 10.1016/j.ejogrb.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
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Najdawi M, Ben Ammar M, Nouri-Neuville M, Barral M, Kermarrec É, Thomassin-Naggara I, Cornelis FH. Cryoablation percutanée de l’endométriose en radiologie interventionnelle. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma. Abdom Radiol (NY) 2020; 45:1800-1812. [PMID: 30003273 DOI: 10.1007/s00261-018-1666-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the clinical, multimodality imaging, and pathologic characteristics of abdominal wall endometriosis (AWE), the most common type of extra-pelvic endometriosis. METHODS 116 women with histopathologically confirmed extragenital endometriosis diagnosed between 2/2014 and 6/2017 were evaluated retrospectively. Of these, 26 (22.4%) were found to have AWE and 18/26 met inclusion criteria for imaging. Available imaging studies were re-reviewed by two expert radiologists. Data regarding clinical features, histopathologic findings, and management were collected through medical record review. RESULTS 21 pathology-proven AWE deposits were identified by imaging in 18 women [mean age at diagnosis of 38.5 years (range 31-48)]. Prior C-section was present in 15/18 (83.3%) and pelvic endometriosis in 3/18 (16.7%) patients. Patients presented with abdominal pain in 14/18 (77.8%) cases, which was cyclical in 8/14; palpable mass in 12/18 (66.7%); fluid discharge in 2/18 (11.1%); and local skin discoloration in 2/18 (11.1%). Of the 21 lesions, 15 were evaluated with US, 10 with CT, and 5 with MRI. Mean lesion dimensions were 2.5 × 2.2 × 2.6 cm, and deposits were predominantly located at midline or left hemiabdomen [22/30 (73.3%)], were either stellate [15/30 (50%)] or round [15/30 (50%)] in shape, had ill-defined margins [21/30 (70%)], were heterogenous in appearance [27/30 (90%)], and involved both deep and superficial abdominal wall layers [17/30 (56.7%)]. On US, lesions were mainly isoechoic/hyperechoic [7/15 (46.7%)], and scarcely vascular [8/15 (53.3%)] with a peripheral vascular pattern [8/13 (61.5%)]. On CT, AWEs were hypervascular and homogeneous [8/10 (80%)], superiorly located to scar tissue, and on MRI lesions appeared hyperintense [4/5 (80%)] to muscle with T2 cystic and T1 hemorrhagic foci [4/5 (80%)]. In 23/27 (85.1%) original reports, there was at least one known mass prior to imaging; AWE was correctly diagnosed in only 7/23 (30.4%) cases. In those with no prior knowledge of a mass, the lesion was detected in 3/4 (75%), but AWE was only diagnosed in a single case. Median time between onset of symptoms and histopathology was 24.41 moths (IQR 15.18-47.33). CONCLUSIONS AWE is a challenging clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. Familiarity with its radiologic features holds the potential for positively impacting diagnosis.
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Guerriero S, Conway F, Pascual MA, Graupera B, Ajossa S, Neri M, Musa E, Pedrassani M, Alcazar JL. Ultrasonography and Atypical Sites of Endometriosis. Diagnostics (Basel) 2020; 10:diagnostics10060345. [PMID: 32471042 PMCID: PMC7345680 DOI: 10.3390/diagnostics10060345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present.
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Affiliation(s)
- Stefano Guerriero
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
- Correspondence:
| | - Francesca Conway
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Betlem Graupera
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Silvia Ajossa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Manuela Neri
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Eleonora Musa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Marcelo Pedrassani
- Hospital Maternidade Carmela Dutra and ClinusClínica de Imagem, Florianopolis 88015–270, Brazil;
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, 31008 Pamplona, Navara, Spain;
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Oestrogen receptors and hypoxia inducible factor 1 alpha expression in abdominal wall endometriosis. Reprod Biomed Online 2020; 41:11-18. [PMID: 32444257 DOI: 10.1016/j.rbmo.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/23/2020] [Accepted: 03/05/2020] [Indexed: 11/20/2022]
Abstract
RESEARCH QUESTION What are the protein levels and localization of oestrogen receptors (including ERa, ERb and G protein-coupled oestrogen receptor [GPER]) and hypoxia-inducible factor-1alpha (HIF-1a) in normal control endometrium (COEM) and ectopic endometrium from abdominal wall endometriosis (AWE). DESIGN AWE (n = 20) were obtained during surgery; COEM (n = 40) were collected by curettage. All tissues were obtained during the proliferative or secretory phase. Formalin-fixed paraffin-embedded tissues were used for immunohistochemical study for oestrogen receptors and HIF-1a proteins. RESULT(S) The expression of oestrogen receptors and HIF-1a in AWE differed from that in the corresponding menstrual cycle phase of COEM. Compared with COEM, ERa and HIF-1a were decreased whereas ERb and GPER were increased in AWE. The greatest difference was in GPER, with increased protein expression in both the cytoplasm and nucleus of endometrial epithelial and stromal cells, as well as a distinct change in localization from cytoplasmic expression to nuclear and cytoplasmic expression, compared with COEM. CONCLUSIONS Our data suggest that the expression changes of oestrogen receptors and HIF-1a, especially GPER, are associated with AWE, which may provide new clues to understanding the cause of endometriosis.
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Cocco G, Ricci V, Boccatonda A, Schiavone C. Focused ultrasound for the diagnosis of non-palpable endometriotic lesions of the abdominal wall: a not-uncommon surgical complication. J Ultrasound 2020; 23:183-187. [PMID: 31919810 DOI: 10.1007/s40477-019-00425-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022] Open
Abstract
Endometriosis is a benign disease characterized by endometrial glands and stroma outside the endometrial cavity. We reported two cases of endometriosis of the abdominal wall, with subcutaneous and intramuscular localization, that became symptomatic a few years after a cesarean intervention. These cases have a clinical pattern quite similar to cutaneous endometriosis, but they are more difficult to diagnose through physical examination because they are barely palpable. In this sense, coupled with suggestive symptoms, ultrasound examination can confirm the clinical suspicion of endometriosis without the use of computed tomography and/or magnetic resonance imaging.
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Affiliation(s)
- Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy.
| | - V Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
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A National Survey of Umbilical Endometriosis in Japan. J Minim Invasive Gynecol 2020; 27:80-87. [DOI: 10.1016/j.jmig.2019.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/03/2019] [Accepted: 02/13/2019] [Indexed: 12/30/2022]
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25
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Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2019. [PMID: 31032131 DOI: 10.1155/2019/6831545.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. Introduction Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. Case Report A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. Discussion The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.
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A Rare Cause of Abdominal Pain: Scar Endometriosis. Emerg Med Int 2019; 2019:2584652. [PMID: 31139471 PMCID: PMC6500653 DOI: 10.1155/2019/2584652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/29/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction. Scar endometriosis (SE) is a rare pathology that develops in the scar tissue formed on the anterior abdominal wall usually after a cesarean section. There have been instances of women presenting to emergency or general surgery clinics with abdominal pain due to SE. Materials and Methods. This study retrospectively reviews 19 patients who were operated on in our clinic between January 2010 and January 2017 with a prediagnosis of SE and were reported to have SE based on their pathology results. Results. The mean age of the patients was 30.8 years (range: 20-49 years). The body mass indexes of 12 (63.2%) patients were ≥ 25. All patients had a history of cesarean section and 9 (47.4%) patients had undergone cesarean section once. With the exception of one patient who had her SE localized in her inguinal region, all patients had a mass localized on their anterior abdominal wall neighboring the incision and complained about cyclic pain starting in their premenstrual periods. The complaints began 2 years after their cesarean section in 10 (52.6%) patients. Mostly abdominal ultrasonography was used for diagnostic purposes. The lesions were totally excised and the SE diagnosis was made through a histopathological examination in all patients. No postoperative complications or recurrences were seen in any of the patients. Conclusion. Suspicion of SE is essential in women of reproductive age who have a history of cesarean section and complaints of an anterior abdominal wall mass and a pain at the scar site that is associated with their menstrual cycle. An accurate and early diagnosis can be established in such patients through a careful history and a good physical examination and possible morbidities can be prevented with an appropriate surgical intervention.
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Vagholkar K, Vagholkar S. Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2019; 2019:6831545. [PMID: 31032131 PMCID: PMC6457300 DOI: 10.1155/2019/6831545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. INTRODUCTION Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. CASE REPORT A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. DISCUSSION The etiopathogenesis, presentation, investigations, and management are discussed briefly. CONCLUSION Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.
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Affiliation(s)
- Ketan Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai 400706, MS, India
| | - Suvarna Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai 400706, MS, India
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Morgado-Carrasco D, Gómez S, Alós L, Giavedoni P. Value of Ultrasound as a Diagnostic Tool for a Painful Thoracic Nodule. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Utilidad de la ecografía en el diagnóstico diferencial de un nódulo doloroso en el tórax. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:570-573. [DOI: 10.1016/j.ad.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/30/2017] [Accepted: 09/03/2017] [Indexed: 11/21/2022] Open
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Genovese G, Passoni E, Veraldi S, Nazzaro G. Ultrasonographic findings in primary umbilical endometriosis. An Bras Dermatol 2018; 93:297-298. [PMID: 29723349 PMCID: PMC5916414 DOI: 10.1590/abd1806-4841.20187076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/04/2017] [Indexed: 11/21/2022] Open
Abstract
Primary cutaneous endometriosis is a rare condition. It appears without a prior history of surgical procedure and the umbilicus is the most frequently involved area. Primary umbilical endometriosis, or Villar's nodule, usually presents as a painful nodule. Its differential diagnosis may be challenging. Although histopathological assessment represents the gold standard for diagnosis, cutaneous ultrasonography may be useful in guiding the surgical treatment. Ultrasonographic features of cutaneous endometriosis have not yet been fully explored in the literature. Hence, we report peculiar ultrasonographic findings of primary umbilical endometriosis.
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Affiliation(s)
- Giovanni Genovese
- Department of Medical and Surgical Pathophysiology and
Transplantation, Università degli Studi di Milano, Operative Unit of
Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico
(IRCCS) Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
| | - Emanuela Passoni
- Department of Medical and Surgical Pathophysiology and
Transplantation, Università degli Studi di Milano, Operative Unit of
Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico
(IRCCS) Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
| | - Stefano Veraldi
- Department of Medical and Surgical Pathophysiology and
Transplantation, Università degli Studi di Milano, Operative Unit of
Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico
(IRCCS) Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
| | - Gianluca Nazzaro
- Department of Medical and Surgical Pathophysiology and
Transplantation, Università degli Studi di Milano, Operative Unit of
Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico
(IRCCS) Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
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Edwards K, Tsai SH, Kothari A. Clinical and imaging features of abdominal wall endometriomas. Australas J Ultrasound Med 2018; 21:24-28. [DOI: 10.1002/ajum.12076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kylie Edwards
- Bundaberg Hospital; 271 Bourbong Street Bundaberg Queensland 4670 Australia
- The University of Queensland; St Lucia Queensland 4072 Australia
| | - Shih-Han Tsai
- Redcliffe Hospital; Anzac Avenue Redcliffe Queensland 4020 Australia
| | - Alka Kothari
- The University of Queensland; St Lucia Queensland 4072 Australia
- Redcliffe Hospital; Anzac Avenue Redcliffe Queensland 4020 Australia
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Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature. J Radiol Case Rep 2017; 11:16-26. [PMID: 29290906 DOI: 10.3941/jrcr.v11i12.3178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.
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Affiliation(s)
- Madison Kocher
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hardie
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Schaefer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas McLaren
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Mark Kovacs
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
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Malutan AM, Simon I, Ciortea R, Mocan-Hognogi RF, Dudea M, Mihu D. Surgical scar endometriosis: a series of 14 patients and brief review of literature. ACTA ACUST UNITED AC 2017; 90:411-415. [PMID: 29151790 PMCID: PMC5683831 DOI: 10.15386/cjmed-743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/13/2016] [Accepted: 12/28/2016] [Indexed: 12/20/2022]
Abstract
Background and aims Endometriosis is a commonly encountered disorder in women of reproductive age, consisting of the presence of active ectopic endometrial tissue outside the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnostic tools and therapeutic options in abdominal wall endometriosis (AWE). Methods We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution. Results The main characteristic of AWE were emphasized, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% of all cases an accurate diagnosis of AWE was established preoperatively. Conclusion A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased.
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Affiliation(s)
- Andrei Mihai Malutan
- 2 Obstetrics and Gynecology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Simon
- 4 Surgical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Razvan Ciortea
- 2 Obstetrics and Gynecology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Florin Mocan-Hognogi
- 2 Obstetrics and Gynecology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marina Dudea
- 2 Obstetrics and Gynecology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Mihu
- 2 Obstetrics and Gynecology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Mooney SS, Ellett L. Umbilical endometriosis: a potential encounter for general surgeons. ANZ J Surg 2017; 89:440-442. [PMID: 28768362 DOI: 10.1111/ans.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/28/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Samantha S Mooney
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Lenore Ellett
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Yarmish G, Sala E, Goldman DA, Lakhman Y, Soslow RA, Hricak H, Gardner GJ, Vargas HA. Abdominal wall endometriosis: differentiation from other masses using CT features. Abdom Radiol (NY) 2017; 42:1517-1523. [PMID: 28004137 DOI: 10.1007/s00261-016-0998-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall. METHODS Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations between CT features and pathology were tested using Fisher's Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing. RESULTS 24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P = 0.0188), homogeneous density (P = 0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., "gorgon" sign) (P < 0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48-0.86) and specificity (0.97, 95% CI: 0.91-1.00) for both readers occurred for patients having all three of these features present. Border type (P = 0.0199) was only significant for R2, peritoneal extension (P = 0.0188) was only significantly for R1, and the remainder of features were insignificant (P = 0.06-60). There was overlap in Hounsfield units on non-contrast CT (N = 26) between AWE (median: 45HU, range: 39-54) and other abdominal wall masses (median: 38.5HU, range: 15-58). CONCLUSION CT features are helpful in differentiating AWE from other abdominal wall soft tissue masses. Such differentiation may assist decisions regarding possible biopsy and treatment planning.
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Affiliation(s)
- Gail Yarmish
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA.
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Primary umbilical endometriosis: A painful swelling in the umbilicus concomitantly with menstruation. Int J Surg Case Rep 2016; 28:78-80. [PMID: 27689524 PMCID: PMC5043392 DOI: 10.1016/j.ijscr.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary umblikal endometriosis is a rare illness. In this report we aimed to discuss the management of this rare condition. CASE SUMMARY A 28-year-old nulliparous woman was present at our clinic who was suffering from painful swelling in the umbilicus during her menstruation for the last 3 months. Her examination showed a dark-color sensitive nodule of 20×15mm in size in the umbilicus. A lower abdominal tomography was performed to exclude the presence of a concomitant pelvic endometriosis, and it showed increased density consistent with subcutaneous inflammation in the umbilicus. Her medical history and physical examination suggested primary umbilical endometriosis. A total resection including umbilicus was performed. DISCUSSION Primary umbilical endometriosis is a rare benign disease and clinically difficult to differentiate from other diseases that cause umbilical nodule. Imaging modalities have no pathognomonic findings for diagnosis. Surgical exploration and excision are the definitive and safe treatment of primary umbilical endometriosis. CONCLUSION Total umbilical resection should be preferred to avoid local recurrent.
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Gachabayov M, Horta R, Afanasyev D, Gilyazov T. Abdominal wall endometrioma: Our experience in Vladimir, Russia. Niger Med J 2016; 57:329-333. [PMID: 27942100 PMCID: PMC5126745 DOI: 10.4103/0300-1652.193858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Subjects and Methods: A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed. Results: In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma. Conclusion: Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE.
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Affiliation(s)
- Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Roman Horta
- Department of Gynecology, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Dmitriy Afanasyev
- Ambulatory Surgery Center, Vladimir City Clinical Hospital No. 5, Vladimir, Russia
| | - Timur Gilyazov
- Department of General Surgery, Oblast Clinical Hospital, Vladimir, Russia
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Pandey D, Sharma R, Salhan S. Catamenial Pain in Umbilical Hernia with Spontaneous Reduction: An Unusual Presentation of a Rare Entity. J Clin Diagn Res 2015; 9:QD09-11. [PMID: 26436005 DOI: 10.7860/jcdr/2015/12778.6310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022]
Abstract
Spontaneous umbilical endometriosis occurring in absence of any previous abdominal or uterine surgery is extremely atypical. Its association with umbilical hernia is very rare and hernia getting spontaneously resolved has not been reported in literature so far. Here we report a case of a patient with spontaneous umbilical endometriosis associated with umbilical hernia which led to spontaneous hernia reduction. This was also associated with multiple uterine fibromyoma and bilateral ovarian endometrioma which were simultaneously treated by total abdominal hysterectomy with bilateral salpingo-oopherectomy along with surgical excision of the endometriotic tissue and repair of the abdominal wall defect. To the best of our knowledge, this is the first described case of spontaneous umbilical hernia reduction due to development of endometriosis.
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Affiliation(s)
- Divya Pandey
- Assistant Professor, Department of Obstetrics and Gynaecology, NDMC Medical College, Hindu Rao Hospital , Delhi, India
| | - Ritu Sharma
- Assistant Professor, Department of Obstetrics and Gynaecology, NDMC Medical College, Hindu Rao Hospital , Delhi, India
| | - Sudha Salhan
- Professor and Unit Head, Department of Obstetrics and Gynaecology, NDMC Medical College, Hindu Rao Hospital , Delhi, India
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Diagnosis and treatment of perineal endometriosis: review of 17 cases. Arch Gynecol Obstet 2015; 292:1295-9. [PMID: 26041323 DOI: 10.1007/s00404-015-3756-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/11/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To demonstrate the appropriate diagnosis and treatment of perineal endometriosis. METHODS Seventeen patients who presented with a tender perineal mass coinciding with the menstrual cycle on the scar of a previous vaginally procedure were examined retrospectively. Their clinical features and treatment were analyzed. RESULTS All patients presented with a palpable painful lesion. All of them had had vaginal delivery with episiotomy. The mean age of the patients was 34.35 years. The mean latent period was 46.82 months. The mean size was 2.38 cm. Thirteen patients presented with one subcutaneous nodule and four had multiple nodules. Color Doppler ultrasound revealed a subcutaneous nodule with an irregular outline and echo-complex density underlying the episiotomy scar. Only one patient suffered from perineal endometriosis combined with pelvic endometriosis. All endometriotic masses in perineum were completely excised and cured, and confirmed by the microscopic examination. CONCLUSIONS A detailed history and thorough pelvic examination are essential in diagnosing perineal endometriosis. Surgical intervention is the first choice of treatment.
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Theunissen CIJM, IJpma FFA. Primary umbilical endometriosis: a cause of a painful umbilical nodule. J Surg Case Rep 2015; 2015:rjv025. [PMID: 25786440 PMCID: PMC4363684 DOI: 10.1093/jscr/rjv025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A female patient presented with a painful swelling in the umbilicus. Ultrasonography demonstrated a hypodense nodule of 1.8 cm. Surgical exploration revealed a subcutaneous, dark discoloured, lobulated swelling at the bottom of the umbilicus, which turned out to be primary umbilical endometriosis (PUE). Primary umbilical endometriosis is a rare and benign disorder, caused by the presence of ectopic endometrial tissue in the umbilicus, which can present as a painful, discoloured swelling in the umbilicus. The clinical distinction between primary umbilical endometrioses and other causes of an umbilical nodule is difficult. Additional imaging modalities do not show any pathognomonic signs for establishing this diagnose. Surgical exploration and excision are a safe and definitive treatment of primary umbilical endometrioses. This case highlights the importance of including PUE in the differential diagnosis of women with a painful umbilical nodule.
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Affiliation(s)
| | - Frank F A IJpma
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
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Cozzolino M, Magnolfi S, Corioni S, Moncini D, Mattei A. Abdominal Wall Endometriosis on the Right Port Site After Laparoscopy: Case Report and Literature Review. Ochsner J 2015; 15:251-255. [PMID: 26412997 PMCID: PMC4569157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Endometriosis can be intrapelvic or, rarely, extrapelvic. Endometriosis involving the rectus abdominis muscle on the trocar port site is a rare event; until now, only 16 cases have been reported in the literature. The majority of cases were associated with previous abdominal surgery such as diagnostic laparoscopy, cyst excision, appendectomy, myomectomy, or cholecystectomy. We review all the reported cases of this unusual form of extrapelvic endometriosis. CASE REPORT We report a new case of abdominal wall endometriosis at the trocar port site in the rectus abdominis muscle in a woman who had undergone 2 laparoscopies for endometriosis in the 3 years before coming to our attention. The diagnosis was made by sonography. We performed a surgical resection of the lesion with a free macroscopic margin of 5-10 mm. CONCLUSION Endometriosis should be considered in the differential diagnosis of any abdominal swelling. In our experience, surgery is the treatment of choice.
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Affiliation(s)
- Mauro Cozzolino
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Stefania Magnolfi
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Serena Corioni
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Daniela Moncini
- Department of Biomedicine, Histology, and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Alberto Mattei
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
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Khamechian T, Alizargar J, Mazoochi T. 5-Year data analysis of patients following abdominal wall endometrioma surgery. BMC WOMENS HEALTH 2014; 14:151. [PMID: 25476548 PMCID: PMC4263010 DOI: 10.1186/s12905-014-0151-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022]
Abstract
Background Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium embedded in the subcutaneous fatty layer and the muscles of abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a rare condition; however, it is usually known to develop along with previous surgical scars. Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE. Methods We evaluated the data of the patients who underwent AWE surgery between March 2009 and March 2014. Results The mean age of the patients was 32.5 years. We found a previous history of caesarean section in all of the patients. The most frequent symptoms of the patients were abdominal mass sensation and abdominal pain. Invasion of endometriosis to fat layer, fascia, muscular layer, and peritoneum was recorded. Three masses were located within the scar regions. Conclusions We can conclude that there is a high prevalence of caesarean sections among the women with AWE.
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Affiliation(s)
- Tahere Khamechian
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, I.R Iran.
| | - Javad Alizargar
- Student Research Committee, Kashan University of Medical Sciences, Kashan, I.R. Iran.
| | - Tahere Mazoochi
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, I.R Iran.
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Moshiri M, Osman S, Bhargava P, Maximin S, Robinson TJ, Katz DS. Imaging Evaluation of Maternal Complications Associated with Repeat Cesarean Deliveries. Radiol Clin North Am 2014; 52:1117-35. [DOI: 10.1016/j.rcl.2014.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Coccia ME, Rizzello F, Nannini S, Cozzolino M, Capezzuoli T, Castiglione F. Ultrasound-guided excision of rectus abdominis muscle endometriosis. J Obstet Gynaecol Res 2014; 41:149-52. [DOI: 10.1111/jog.12502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Francesca Rizzello
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Sara Nannini
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Mauro Cozzolino
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Tommaso Capezzuoli
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Francesca Castiglione
- Department of Human Pathology and Oncology; School of Medicine; University of Florence; Florence Italy
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Frequently Misdiagnosed Extrapelvic Endometriosis Lesions: Case Reports and Review of the Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extrapelvic endometriosis is a rare condition defined as the presence of endometriotic stroma and glands outside the pelvis and elsewhere in the body. The cervix, vagina, vulva, intestinal tract, urinary tract, diaphragm, abdominal wall, inguinal canal, thoracic cage and lungs, extremities and even the central and peripheral nervous system can be involved. Because extrapelvic endometriosis is located in unusual sites, it is often confused with other pathologic conditions. This can lead to a difficult and challenging diagnosis and management. In the presence of recurrent, cyclical and catamenial symptoms, extragenital endometriotic lesions should be suspected. The aim of our paper is to report 9 cases of rare locations of extrapelvic endometriosis and to provide a literature review.
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Abu Saadeh F, Wahab NA, Gleeson N. An unusual presentation of endometriosis. BMJ Case Rep 2014; 2014:bcr-2014-204270. [PMID: 24876213 DOI: 10.1136/bcr-2014-204270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 25-year-old nulliparous woman attended an orthopaedic clinic with a 12-month history of right hip pain and was found to have a hard tender mass in her right groin. Fine-needle aspiration yielded a diagnosis of endometrial glands. The lesion was excised completely and the final diagnosis was round ligament endometriosis. The patient was pain free 3 months postsurgery.
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Abstract
AIM: To evaluate endometrioma located at cesarean scatrix.
METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed.
RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin.
CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.
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Genç B, Solak A, Şahin N, Genç M, Oğul H, Sivrikoz ON, Kantarcı M. Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas. Clin Radiol 2014; 69:130-6. [DOI: 10.1016/j.crad.2013.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/29/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
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Primary Endometriosis of Umbilical Scar: Case Report and Review of Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report a case of umbilical endometriosis and review the literature about the finding. The patient was a 39-year-old woman who presented with 6 months of umbilical bleeding and pain during the first day of her period. A soft tissue ultrasound scan showed 2 superficial solid masses within the periumbilical subcutaneous adipose tissue, suggestive for ectopic endometriosis localization. We decided to remove the umbilical nodules, excising 1 cm of the surrounding tissue. Reports in the literature indicate cases of umbilical endometriosis in about 0.5%-1% of women with endometriosis.
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Fancellu A, Pinna A, Manca A, Capobianco G, Porcu A. Primary umbilical endometriosis. Case report and discussion on management options. Int J Surg Case Rep 2013; 4:1145-1148. [PMID: 24291679 PMCID: PMC3860025 DOI: 10.1016/j.ijscr.2013.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/22/2013] [Accepted: 11/01/2013] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition. PRESENTATION OF CASE A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months. DISCUSSION UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. CONCLUSION Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.
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Affiliation(s)
- Alessandro Fancellu
- Department of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100 Sassari, Italy.
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