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Çayır D, Araz M, Apaydın M, Çakal E. Inguinal Endometriosis Visualized on I-131 Whole Body Scan. Mol Imaging Radionucl Ther 2018; 27:52-54. [PMID: 29393056 PMCID: PMC5790976 DOI: 10.4274/mirt.77044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We present a rare case with inguinal iodine-131 (I-131) uptake on whole body scan. The patient was suffering from a painful right inguinal mass during menstrual period, which was later sonographically and histopathologically confirmed to be an inguinal focus of endometriosis. Endometriosis is a previously reported site of radioiodine uptake and detection of radioiodine uptake in the inguinal region has also been described. Nevertheless, to the best of our knowledge, this is the first case report of I-131 uptake in an inguinal endometriosis focus. History and physical examination of the patient are both very important in identifying the etiology of the ectopic uptake sites on I-131 whole body scan, and inguinal endometriosis should be kept in mind while reporting inguinal radioiodine uptake on I-131 whole body scan.
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Affiliation(s)
- Derya Çayır
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Mine Araz
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Mahmut Apaydın
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Endocrinology and Metabolism, Ankara, Turkey
| | - Erman Çakal
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Endocrinology and Metabolism, Ankara, Turkey
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Ail DA, Joshi AR, Manzoor I, Patil S, Kulkarni M. Fine-needle Aspiration Cytology of Abdominal Wall Endometriosis:
A Meaningful Adjunct to Diagnosis. Oman Med J 2018; 33:72-75. [PMID: 29468004 DOI: 10.5001/omj.2018.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Fine-needle aspiration cytology (FNAC) is a simple, non-invasive diagnostic modality which can be performed with ease on any superficially palpable lesion. Surgical scar endometriosis is a rare entity which presents as an abdominal lump in women of reproductive age. It is often a diagnostic pitfall for clinicians due to its nonspecific symptoms. It displays characteristic morphology, which needs to be identified and recognized by a cytopathologist for accurate diagnosis. FNAC can be used as a key diagnostic tool in cases of abdominal wall mass for appropriate patient management, thereby avoiding unnecessary diagnostic procedures. Here, we report the case of a 35-year-old woman who presented with an abdominal lump where FNAC played a vital role in the patient's management.
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Affiliation(s)
- Divya A Ail
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, India
| | - Avinash R Joshi
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, India
| | - Irmeen Manzoor
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, India
| | - Sukhada Patil
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, India
| | - Maithili Kulkarni
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, India
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Nigam JS, Omhare A, Sharma A. Fine-needle aspiration cytology of a cesarean scar endometriosis. Tzu Chi Med J 2018; 29:232-234. [PMID: 29296054 PMCID: PMC5740698 DOI: 10.4103/tcmj.tcmj_37_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endometriosis is the presence of functioning endometrium outside the basement membrane of the uterine endometrium. It affects women of reproductive age and usually presents as a painful nodule over a period of 3 months to 10 years after surgery. Extrapelvic endometriosis is uncommon and more difficult to diagnose due to its variable presentation and is often confused with other surgical conditions. Fine-needle aspiration cytology (FNAC) is a rapid, cost-effective, and accurate diagnostic tool when making this diagnosis. Wide excision is the treatment of choice for scar endometriosis as well as for recurrent lesions. We present a case of scar endometriosis in a 30-year-old female who had undergone a cesarean section 2 years previously and was diagnosed by FNAC. A later histopathological examination confirmed the cytological diagnosis of scar endometriosis.
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Affiliation(s)
- Jitendra Singh Nigam
- Department of Pathology, Anadman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Anita Omhare
- Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Ankit Sharma
- Department of Pathology, LBS Hospital, New Delhi, India
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Gentile JKDA, Migliore R, Kistenmacker FJN, de Oliveira MM, Garcia RB, Bin FC, de Souza PMSB, Assef JC. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report. SAO PAULO MED J 2018; 136:586-590. [PMID: 29116312 PMCID: PMC9897138 DOI: 10.1590/1516-3180.2017.0103300417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date.
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Affiliation(s)
- João Kleber de Almeida Gentile
- MD. Resident Physician, Department of Digestive Surgery, Hospital do Servidor Público Municipal (HSPM-SP), São Paulo (SP), Brazil.
| | - Renato Migliore
- MD. Resident Physician, Department of Digestive Surgery, Hospital do Servidor Público Municipal (HSPM-SP), São Paulo (SP), Brazil.
| | | | - Marcio Menezes de Oliveira
- MD. Resident of General Surgery, Department of General Surgery, Hospital do Servidor Público Municipal (HSPM), São Paulo (SP), Brazil.
| | - Rodrigo Biscuola Garcia
- MD. Attending Physician, Department of Digestive Surgery, Hospital do Servidor Público Municipal (HSPM-SP), São Paulo (SP), Brazil.
| | - Fang Chia Bin
- MD. Department of Digestive System Surgery, Hospital do Servidor Público Municipal (HSPM-SP), São Paulo (SP), Brazil.
| | | | - José César Assef
- MD. Department of Digestive System Surgery, Hospital do Servidor Público Municipal (HSPM-SP), São Paulo (SP), Brazil.
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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: 0.7] [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: 0.9] [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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58
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Siddiqui ZA, Husain F, Siddiqui Z, Siddiqui M. Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery. BMJ Case Rep 2017. [PMID: 28630240 DOI: 10.1136/bcr-2017-219291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar.
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Affiliation(s)
- Zohaib A Siddiqui
- Student, King's College London School of Medical Education, London, UK
| | - Fahd Husain
- Foundation Year 2, Darent Valley Hospital, Dartford, UK
| | - Zain Siddiqui
- Foundation Year 1, Lewisham and Greenwich NHS Trust, London, UK
| | - Midhat Siddiqui
- Upper GI Consultant Surgeon, Queen Elizabeth Hospital, London, UK
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59
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Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations. Obstet Gynecol Surv 2017; 72:116-122. [PMID: 28218772 DOI: 10.1097/ogx.0000000000000399] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries. Objective This article reviews the diagnosis and management of AWE, a condition that generally develops after surgery but may arise spontaneously. We present a systematic review of the existing literature on AWE, as well as our clinical recommendations for medical and surgical management. Evidence Acquisition We searched PubMed and other databases using the search criteria "abdominal wall endometriosis," "abdominal wall endometriomas," and "abdominal wall mass." The references of those articles were then reviewed, and additional publications were evaluated. Results Many case reports and case series have been published describing AWE. The overall quality of evidence is poor due to the lack of prospective studies and heterogeneous descriptions of AWE lesions and treatment options. Based on the available literature, it appears that AWE may arise spontaneously but is generally associated with prior pelvic surgery. Abdominal wall endometriosis can be diagnosed with a careful history and physical examination. Imaging including ultrasound and magnetic resonance imaging can assist with localization of the lesions, and aid in surgical excision and management. Lesions that have been removed in their entirety are unlikely to reoccur. Conclusions and Relevance Although limited, the body of literature describing management of AWE suggests that it can be successfully treated in most patients with careful surgical planning.
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60
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Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J Minim Invasive Gynecol 2017; 24:478-484. [PMID: 28104496 DOI: 10.1016/j.jmig.2017.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/03/2017] [Accepted: 01/07/2017] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the risk factors, presentation, and outcomes in cases of abdominal wall endometriosis. DESIGN A case-control study (Canadian Task Force classification II-2). SETTING An academic medical center. PATIENTS A total of 102 (34 cases and 68 controls) were included. INTERVENTIONS Surgical resection of abdominal wall endometriosis. MEASUREMENTS AND MAIN RESULTS Cases underwent surgical excision for abdominal wall endometriosis at Mayo Clinic from January 1, 2000, through December 31, 2013. For each case, 2 controls were randomly selected from a list of women who had surgery in the same year with minimal (American Society for Reproductive Medicine stage I-II) endometriosis. A chart review was completed for variables of interest. Regression models were used to identify independent risk factors associated with abdominal wall endometriosis. RESULTS In 14 years, 2539 women had surgery for endometriosis at Mayo Clinic. Of these, only 34 (1.34%) had abdominal wall endometriosis. The mean age was 35.2 ± 5.9 years, and the median parity was 2 (range, 0-5). Clinical examination diagnosed abdominal wall endometriosis in 41% of cases, with the cesarean delivery scar being the most common site (59%). There was a strong correlation between the size of the lesion on clinical examination compared with the size of the pathology specimen (r2 = 0.74, p < .001). When compared with controls, cases had significantly higher parity and body mass index, more cyclic localized abdominal pain, less dysmenorrhea, longer duration from the start of symptoms to surgery, and more gynecologic surgeries for symptoms without cure. In the final multivariable model, cyclic localized abdominal pain, absence of dysmenorrhea, and previous laparotomy were independently associated with abdominal wall endometriosis with adjusted odds ratios of 10.6 (95% CI 1.85-104.4, p < .001), 12.4 (95% CI 1.64-147.1, p < .001), and 70.1 (95% CI 14.8-597.7, p < .001), respectively, with an area under the curve for the receiver operating characteristic of 0.94 (95% CI, 0.87-0.98). After excision of the disease, repeat surgery was needed in 2 (5.9%) patients with a median time to recurrence of 50.5 (range, 36-65) months. CONCLUSIONS Abdominal wall endometriosis is a rare but unique form of endometriosis. Careful history and clinical examination can provide accurate diagnosis and avoid unnecessary delay before surgical intervention. Localized cyclic abdominal pain with the absence of dysmenorrhea and a history of prior laparotomy are independent risk factors with very high accuracy for diagnosis.
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Affiliation(s)
- Zaraq Khan
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
| | - Valentina Zanfagnin
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sherif A El-Nashar
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Abimbola O Famuyide
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Gaurang S Daftary
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Matthew R Hopkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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Scar endometriosis: A series of 3 cases. Med J Armed Forces India 2017; 72:S185-S188. [PMID: 28050109 DOI: 10.1016/j.mjafi.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/10/2016] [Indexed: 12/27/2022] Open
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Mohamed AA, Selim YA, Arif MA, Albroumi SA. Gastric wall endometriosis in a postmenopausal woman. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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63
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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: 0.3] [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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Ramesh B, Chaithra TM, Gupta P, Prasanna G. Anterior Abdominal Wall Scar Endometriosis: An Enigma. J Obstet Gynaecol India 2015; 66:636-638. [PMID: 27803530 DOI: 10.1007/s13224-015-0777-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- B Ramesh
- Dr. Ramesh Hospital, #6/63, 59th Cross, 4th Block, Rajajinagar Entrance, Bengaluru, Karnataka India
| | - T M Chaithra
- Dr. Ramesh Hospital, #6/63, 59th Cross, 4th Block, Rajajinagar Entrance, Bengaluru, Karnataka India
| | - Pooja Gupta
- Dr. Ramesh Hospital, #6/63, 59th Cross, 4th Block, Rajajinagar Entrance, Bengaluru, Karnataka India
| | - G Prasanna
- Dr. Ramesh Hospital, #6/63, 59th Cross, 4th Block, Rajajinagar Entrance, Bengaluru, Karnataka India
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Abstract
Endometriosis is defined as the presence of a functioning endometrium outside the uterus. Abdominal wall endometriosis is a rare entity. Most of the abdominal wall endometriosis occurs in or around surgical scars following caesarean section or hysterectomy. We report a case of scar endometriosis following caesarean section and diagnosed by fine needle aspiration cytology (FNAC). Excision biopsy confirmed the FNAC diagnosis of scar endometriosis.
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Affiliation(s)
- Geeta Pachori
- Department of Pathology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Rashmi Sharma
- Department of Pathology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Ravi Kant Sunaria
- Department of Pathology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Tushar Bayla
- Department of Pathology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
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66
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Al Shakarchi J, Bohra A. Endometrioma in a virgin abdomen masquerading as an intramuscular lipoma. J Surg Case Rep 2015; 2015:rjv023. [PMID: 25786439 PMCID: PMC4363691 DOI: 10.1093/jscr/rjv023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Endometriosis is the presence of endometrial tissue outside the uterine cavity. It has been previously reported in the abdominal wall secondary to gynaecological surgery. We present the case of a 32-year woman with endometrioma of the abdominal wall masquerading as an intramuscular lipoma with no previous surgical history.
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Affiliation(s)
- J Al Shakarchi
- Department of General Surgery, Russells Hall Hospital, Dudley, UK
| | - A Bohra
- Department of General Surgery, Russells Hall Hospital, Dudley, UK
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67
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Husain F, Siddiqui ZA, Siddiqui M. A case of endometriosis presenting as an inguinal hernia. BMJ Case Rep 2015; 2015:bcr-2014-208099. [PMID: 25762576 DOI: 10.1136/bcr-2014-208099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Endometriosis is a common clinical presentation for gynaecologists. Occasionally it can present to general surgeons as a swelling in the groin or abdominal wall. This condition should be included in the differential diagnosis in female patients. A 32-year-old woman with a 2-year history of a painful persistent lump in her right groin was referred to the general surgeons by her general practitioner. She was referred with a diagnosis of a suspected inguinal hernia. MRI excluded a hernia and exploration of the groin and subsequent histology confirmed the lesion to be an endometrial deposit.
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Affiliation(s)
- Fahd Husain
- Peninsula College of Medicine and Dentistry, London, UK
| | - Zain Ahmed Siddiqui
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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68
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Fawzy M, Amer T. Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: A pilot study. J OBSTET GYNAECOL 2015; 35:832-4. [PMID: 25710101 DOI: 10.3109/01443615.2015.1011107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transabdominal sonoelastography (TASE) is a new imaging technique that maps the elastic properties of soft tissue. We evaluated 34, consecutive women with suspected scar endometrioma using standard B-mode ultrasound and elastography. Twenty-three women (23/34) underwent surgical excision and had the diagnosis confirmed by histopathology. All endometriomas (23 patients) in B-mode imaging appeared as hypoechoic masses along the line of a previous caesarean section incision and the outer borders were difficult to define precisely. By TASE, the endometrioma presented a typical blue-green-red appearance and the outer borders were clearly defined. (red and green area corresponds with the central hypoechoic soft areas). Strain ratios varied from 0.02 to 0.75. Real-time TASE is a simple, useful technique in confirming a clinical diagnosis of endometrioma in a caesarean section scar. Compared with B-mode ultrasound, it provides additional, preoperative information about the extent of the lesion that may be helpful to the surgeon.
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Affiliation(s)
- M Fawzy
- a Department of Obstetrics and Gynecology , Radiology Department, Faculty of Medicine, Mansoura University , Mansoura , Egypt
| | - T Amer
- a Department of Obstetrics and Gynecology , Radiology Department, Faculty of Medicine, Mansoura University , Mansoura , Egypt
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Vellido-Cotelo R, Muñoz-González JL, Oliver-Pérez MR, de la Hera-Lázaro C, Almansa-González C, Pérez-Sagaseta C, Jiménez-López JS. Endometriosis node in gynaecologic scars: a study of 17 patients and the diagnostic considerations in clinical experience in tertiary care center. BMC WOMENS HEALTH 2015; 15:13. [PMID: 25783643 PMCID: PMC4337097 DOI: 10.1186/s12905-015-0170-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 01/27/2015] [Indexed: 12/19/2022]
Abstract
Background Endometriosis nodes are observed in extra pelvic locations, particularly in gynaecological scars, with the abdominal wall being one of the most frequent locations. The main objective of the study is to review patient characteristics of cases of endometriosis nodes in gynaecological scars. Methods A retrospective, observational and descriptive study with a cohort of patients from Hospital 12 de Octubre was conducted from January 2000 to January 2012. We analysed all of the patients who presented with an endometriosis node in a gynaecological scar presentation who had undergone surgery in that period. Descriptive data were collected and analysed. Results A total of 17 patients with an anatomopathological diagnosis of an endometriosis node in a gynaecological scar were found. The following variables were studied: the age at diagnosis (32.5 years +/− 5.5 years), personal and obstetric history, time from surgery to diagnosis (4.2 years +/− 3.4 years), symptoms (a painful mass that grows during menstruation is the most frequent symptom in our patients), technical analyses by computed tomography (CT), magnetic resonance (MR) or fine needle aspiration (FNA) (77% of the patients), node size (2.5 cm +/− 1.1 cm) and location (caesarean scar, 82%; episiotomy scar, 11.7%; and laparoscopic surgery port, 5.8%), involvement of adjacent structures (29% of the patients), treatment (exeresis with a security margin in all the patients) and other endometriosis locations (14% of the patients). Conclusions A high level of suspicion is required to diagnose gynaecological scar endometriosis, which should be suspected in the differential diagnosis of scar masses in reproductive-aged women. Several theories have been proposed to explain the formation of endometriosis nodes in extrauterine localizations. The two of them that seem to be more plausible are the metaplasia and transport theories. Imaging with ultrasound, CT and MR facilitate the diagnosis. FNA could be used for preoperative diagnosis. Treatment must be by node resection with a security margin. In some cases, surgery could be combined with hormonal treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0170-9) contains supplementary material, which is available to authorized users.
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70
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Ha JK, Choi CW, Kim HW, Kang DH, Park SB, Kim SJ, Hong JB. An extremely rare case of gastric subepithelial tumor: gastric endometriosis. Clin Endosc 2015; 48:74-7. [PMID: 25674531 PMCID: PMC4323438 DOI: 10.5946/ce.2015.48.1.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 11/25/2022] Open
Abstract
Endometriosis is a disease characterized by the presence of endometrial tissue outside of the uterine cavity. It is common in women of childbearing age, and is most frequently located in the pelvic cavity. Approximately 10% of endometriosis cases occur outside of the pelvic cavity in locations such as the intestines, genitourinary system, kidneys, lungs, and skin. However, there have been few reports of endometriosis in the stomach. Here, we report a rare case of endometriosis that presented as a subepithelial stomach tumor.
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Affiliation(s)
- Jong Kun Ha
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Beom Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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71
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Soft-tissue masses in the abdominal wall. Clin Radiol 2014; 69:e422-31. [DOI: 10.1016/j.crad.2014.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/05/2014] [Accepted: 06/06/2014] [Indexed: 02/07/2023]
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72
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Romera-Barba E, Castañer-Ramón-Llín J, Sánchez Pérez A, Navarro-García I, Rueda-Pérez JM, Cano Maldonado AJ, Vázquez-Rojas JL. Endometriosis umbilical primaria. A propósito de 6 casos. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rehah.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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73
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Misser SK, Steer DB, Purcell S. Body imaging: Diagnosis. SA J Radiol 2014. [DOI: 10.4102/sajr.v18i1.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
No abstract.
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74
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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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75
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Rekhi B, Sugoor P, Patil A, Shylasree TS, Kerkar R, Maheshwari A. Cytopathological features of scar endometriosis mimicking an adenocarcinoma: A diagnostic pitfall. J Cytol 2014; 30:280-3. [PMID: 24648677 PMCID: PMC3945634 DOI: 10.4103/0970-9371.126672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scar endometriosis can be a diagnostic challenge in fine-needle aspiration cytology (FNAC) smears that at times, is the first diagnostic modality in such cases. The challenge is amplified when the clinical details are limited and cytopathological features reveal nuclear atypia. A 33-year-old lady presented with an abdominal swelling that she noticed after she met with a scald. Clinically, the swelling was located lateral to her 3-year-old pfannenstiel incision scar. The initial diagnosis on FNAC was metastatic adenocarcinoma. On review, smears were hypercellular, comprising epithelial cells in groups and focally, regular glandular arrangements, imperceptibly admixed with numerous, relatively smaller, short spindly cells. Epithelial cells exhibited mild to focally, moderate nuclear enlargement/atypia. Subsequent biopsy and excision revealed endometrial glands exhibiting focal nuclear atypia with adjacent stroma. Diagnosis of endometriosis was offered. The results were reinforced with positive estrogen receptor staining in the glands and stroma, along with CD10 positivity in the stroma. The patient was recommended gonadotropin releasing hormone analogs and is presently free of disease a year after her diagnosis. FNAC can be a pitfall in the diagnosis of endometriosis. Correct diagnosis has significant therapeutic implications. Although presence of atypia in such cases should not delude the diagnosing cytopathologist for consideration of endometriosis, it should be documented. The value of clinical history in such cases cannot be overemphasized.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Pawan Sugoor
- Department of Surgical Oncology (Gynaecology), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Surgical Oncology (Gynaecology), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Rajendra Kerkar
- Department of Surgical Oncology (Gynaecology), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Surgical Oncology (Gynaecology), Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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76
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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: 1.3] [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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77
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Akdemir A, Akman L, Yavuzsen HT, Zekioglu O. Clinical features of patients with endometriosis on the cesarean scar. Kaohsiung J Med Sci 2014; 30:541-3. [PMID: 25438688 DOI: 10.1016/j.kjms.2013.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/20/2013] [Accepted: 12/03/2013] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University Medical School, Izmir, Turkey
| | - Levent Akman
- Department of Obstetrics and Gynecology, Ege University Medical School, Izmir, Turkey.
| | | | - Osman Zekioglu
- Department of Pathology, Ege University Medical School, Izmir, Turkey
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78
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Fargas Fàbregas F, Cusidó Guimferrer M, Tresserra Casas F, Baulies Caballero S, Fábregas Xauradó R. Malignant transformation of abdominal wall endometriosis with lymph node metastasis: Case report and review of literature. GYNECOLOGIC ONCOLOGY CASE REPORTS 2014; 8:10-3. [PMID: 24567887 PMCID: PMC3930813 DOI: 10.1016/j.gynor.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/26/2013] [Indexed: 11/26/2022]
Abstract
A simple endometriosis can result in malignancy pathology, as a neoplasia. Wall-abdominal tumors and soft tissue as a possible differential diagnosis of abdominal wall endometriosis Preperitoneal node-metastasis as malignancy of endometriosis in previous cesarean scar
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79
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Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N, Katsikogiannis N, Sarika E, Courcoutsakis N, Tsiouda T, Gschwendtner A, Zarogoulidis K, Sakkas L, Baliaka A, Machairiotis C. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagn Pathol 2013; 8:194. [PMID: 24294950 PMCID: PMC3942279 DOI: 10.1186/1746-1596-8-194] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/23/2013] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvicdepending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinarytract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those.
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Affiliation(s)
| | | | | | - Paul Zarogoulidis
- Pulmonary Department, "G, Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Exohi 1100, 57010 Thessaloniki, Greece.
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80
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Nardi N, Campillo-Gimenez B, Pong S, Branchu P, Ecoffey C, Wodey E. Douleurs chroniques après césarienne : impact et facteurs de risque associés. ACTA ACUST UNITED AC 2013; 32:772-8. [DOI: 10.1016/j.annfar.2013.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
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81
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Gundogdu B, Ureyen I, Kimyon G, Turan H, Boran N, Tulunay G, Bulbul D, Turan T, Kose MF. Primary abdominal wall clear cell carcinoma arising from incisional endometriosis. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2013. [DOI: 10.1016/s2305-0500(13)60155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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82
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Endometriosis umbilical primaria. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2012.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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83
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Xie M, Zhang X, Zhan J, Ren Y, Wang W. Potential role of strain elastography for detection of the extent of large-scar endometriosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1635-1642. [PMID: 23980226 DOI: 10.7863/ultra.32.9.1635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical value of strain elastography for detection of the lesion extent of large-scar endometriosis and compare it to conventional sonography and magnetic resonance imaging (MRI). METHODS Eight patients suspected of having large-scar endometriosis underwent transabdominal sonography, strain elastography, and MRI. The mass was located and assessed for its size, imaging appearance, and, especially, widest boundary and vertical extent. After wide surgical excision and pathologic diagnosis, lesions in the central area shown on conventional sonography and the extended area shown on strain elastography underwent immunohistochemical examination. RESULTS Nodules were always deep in the subcutaneous plane, in contact with the fascia or muscle. Horizontally, the mean lesion size shown on conventional sonography was mainly consistent with the size on MRI in all cases, but it was obviously smaller on sonography than on strain elastography in 7 cases. Vertically, the lesion depth was mainly consistent with the depth on MRI in 7 cases, but it was more infiltrative on strain elastography in 6 cases. The vertical and horizontal infiltration scales of the postoperative specimens were consistent with strain elastography in all cases. All 8 patients showed strong collagen type I expression in the central area of the lesions; 6 patients showed strong collagen type I expression and the other 2 showed moderate expression in the extended area. CONCLUSIONS Strain elastography can elevate the diagnostic accuracy of large-scar endometriosis, the extent of which may be evaluated insufficiently by transabdominal sonography and MRI.
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Affiliation(s)
- Meng Xie
- Department of Ultrasound, Obstetrics and Gynecology Hospital, Fudan University, 128 Shen Yang Rd, 200090 Shanghai, China
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84
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Pernin M, Gervaise A, Fixot K, Junca-Laplace C, Portron Y, Lapierre-Combes M. Une masse de la paroi abdominale. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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85
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Solak A, Genç B, Yalaz S, Sahin N, Sezer TÖ, Solak I. Abdominal wall endometrioma: ultrasonographic features and correlation with clinical findings. Balkan Med J 2013; 30:155-60. [PMID: 25207093 DOI: 10.5152/balkanmedj.2012.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/17/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher's exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.
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Affiliation(s)
- Aynur Solak
- Department of Radiology, Şifa University Faculty of Medicine, İzmir, Turkey
| | - Berhan Genç
- Department of Radiology, Şifa University Faculty of Medicine, İzmir, Turkey
| | - Seyhan Yalaz
- Department of General Surgery, Şifa University Faculty of Medicine, İzmir, Turkey
| | - Neslin Sahin
- Department of Radiology, Şifa University Faculty of Medicine, İzmir, Turkey
| | - Taylan Özgür Sezer
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ilhami Solak
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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86
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Biswas BK, Gupta N, Magon N. Incisional endometriosis: A rare cause for a painful scar - A report and commentary. Niger Med J 2013; 53:257-9. [PMID: 23661890 PMCID: PMC3640251 DOI: 10.4103/0300-1652.107607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10-15% of all women in their reproductive age will develop endometriosis and 25-35% of all women who are infertile have endometriosis. Incisional endometriosis (IE) is a rare entity reported in 0.03-1.08% of women following obstetric or gynaecologic surgeries. Most cases reported in literature have appeared after caesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a painful troublesome scar after a caesarean section is presented.
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Affiliation(s)
- Brijesh K Biswas
- Department of General Surgery, Military Hospital, Gaya, Bihar, India
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87
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Uzunçakmak C, Güldaş A, Özçam H, Dinç K. Scar endometriosis: a case report of this uncommon entity and review of the literature. Case Rep Obstet Gynecol 2013; 2013:386783. [PMID: 23762683 PMCID: PMC3665185 DOI: 10.1155/2013/386783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/17/2013] [Indexed: 11/17/2022] Open
Abstract
Scar endometriosis is an infrequent type of extrapelvic endometriosis that is rather close together with obstetrical and gynecological surgeries. It is mostly confused with other dermatological or surgical conditions and delays the diagnosis. We report a case of a 50-year-old woman presenting with scar endometriosis 23 years after her last lower segment caesarean section. The epidemiology, diagnosis, pathogenesis, and treatment of the situation are discussed.
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Affiliation(s)
- Cihangir Uzunçakmak
- Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey
| | - Ahmet Güldaş
- Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey
| | - Hasene Özçam
- Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey
| | - Kemal Dinç
- Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey
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88
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Audebert A. [Iatrogenic endometriosis during reproductive age: main issues?]. ACTA ACUST UNITED AC 2013; 41:322-7. [PMID: 23660480 DOI: 10.1016/j.gyobfe.2012.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 06/11/2012] [Indexed: 12/25/2022]
Abstract
Among endometriotic lesions a small proportion is secondary to various medical activities, and may be considered as iatrogenic. Any medical or surgical procedure increasing the menstrual flow or the retrograde flow bears a potential risk: conization, hydrotubation or copper intra-uterine device. Surgical procedures, by laparotomy or laparoscopic approach, are able to favor transport and cutaneous seeding of endometrial tissue, especially when a hysterotomy has been performed. Diagnosis and treatment of these lesions are today standardized. Few preventive measures are available, besides adequate surgical procedure, but none has been properly evaluated, mainly because these lesions are not frequent.
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89
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Krüger K, Behrendt K, Niedobitek-Kreuter G, Koltermann K, Ebert AD. Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis. Eur J Obstet Gynecol Reprod Biol 2013; 169:93-8. [PMID: 23478073 DOI: 10.1016/j.ejogrb.2013.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/05/2012] [Accepted: 02/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the value of magnetic resonance imaging (MRI) in the preoperative diagnosis of specific anatomical locations of endometriosis. STUDY DESIGN Between July 2008 and April 2011, 152 women (mean age 33.5 ± 6.1 years) with clinical and sonographic suspicion of endometriosis underwent pelvic MRI using T2 and unenhanced T1 sequences with and without fat saturation. Two radiologists interpreted the following regions by consensus according to a standardized protocol: ovaries, vagina, pouch of Douglas, rectosigmoid colon, uterosacral ligament (USL), bladder, peritoneum, and other pelvic regions. The results of MRI were retrospectively correlated with the laparoscopic and histopathologic findings. The main outcome parameters, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and the negative likelihood ratio (LR-), were determined. RESULTS Sensitivity, specificity, PPV, NPV, accuracy, positive and the negative likelihood ratio were 87.6%, 84.6%, 94.3%, 70.2%, 86.8%, 5.69 and 0.15 for the pouch of Douglas (vagina: 81.4%, 81.7%, 79.2%, 83.8%, 81.6%, 4.45, 0.23; rectosigmoid colon: 80.2%, 77.5%, 80.2%, 77.5%, 78.9%, 3.56, 0.25; USL: 77.5%, 68.2%, 77.5%, 68.2%, 73.7%, 2.44, 0.33; ovaries: 86.3%, 73.6%, 78.4%, 82.8%, 80.3%, 3.27, 0.19; urinary bladder: 81.0%, 94.7%, 70.8%, 96.9%, 92.8%, 15.15, 0.20; peritoneum: 35.3%, 88.1%, 60.0%, 73.0%, 70.4%, 2.97, 0.73). All endometriotic implants at other localization were detected (abdominal wall in 4, groin in one patient). CONCLUSIONS The value of MRI in preoperative diagnosis of endometriosis is dependent on the location of endometriosis. The highest accuracy was found in bladder endometriosis and the lowest in peritoneal endometriosis.
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Affiliation(s)
- Karsten Krüger
- Department of Radiology, Vivantes - Network for Health, Humboldt-Hospital, Berlin, Germany.
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90
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Unexpected encounter with painless endometriosis during abdominoplasty. Aesthetic Plast Surg 2013; 37:173-6. [PMID: 23307055 DOI: 10.1007/s00266-012-0032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Subcutaneous endometriomas are cystic lesions that are rarely described. During the course of abdominoplasty surgery, a "surprise" encounter with a cyst containing brown material brought up the possibility that an atypical incarcerated hernia was entered. Dissection revealed no connection between the cyst and the rectus fascia and subsequent pathologic evaluation revealed an endometrioma. This report describes the unusual encounter with a painless endometrioma during abdominoplasty. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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91
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Mistrangelo M, Gilbo N, Cassoni P, Micalef S, Faletti R, Miglietta C, Brustia R, Bonnet G, Gregori G, Morino M. Surgical scar endometriosis. Surg Today 2013; 44:767-72. [PMID: 23307296 DOI: 10.1007/s00595-012-0459-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/24/2012] [Indexed: 11/24/2022]
Abstract
Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2% of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients.
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Affiliation(s)
- Massimiliano Mistrangelo
- Department of Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, Molinette Hospital, University of Turin, Cso A.M. Dogliotti 14, 10126, Turin, Italy,
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92
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Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, Katz DS. Endometriosis of Abdominal and Pelvic Wall Scars: Multimodality Imaging Findings, Pathologic Correlation, and Radiologic Mimics. Radiographics 2012; 32:2031-43. [DOI: 10.1148/rg.327125024] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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93
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Kang J, Baek JH, Lee WS, Cho TH, Lee JN, Lee WK, Chung M. Clinical manifestations of abdominal wall endometriosis: a single center experience. Arch Gynecol Obstet 2012; 287:301-5. [DOI: 10.1007/s00404-012-2565-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 09/10/2012] [Indexed: 11/30/2022]
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94
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Simoglou C, Zarogoulidis P, Machairiotis N, Porpodis K, Simoglou L, Mitrakas A, Esebidis A, Sarika E, Kouklakis G, Iordanidis A, Katsikogiannis N. Abdominal wall endometrioma mimicking an incarcerated hernia: a case report. Int J Gen Med 2012; 5:569-71. [PMID: 22807645 PMCID: PMC3396112 DOI: 10.2147/ijgm.s32904] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The case of a tender, isolated abdominal wall tumor within a Pfannenstiel incision due to a seeding deposit of endometrial tissue secondary to a previous obstetric operation (caesarean section) in a 39-year-old female without previously reported pelvic endometriosis is presented. The lesion clinically mimicked the appearance of an incarcerated incisional hernia at the outer corner of the healed Pfannenstiel incision. The preoperative differential diagnosis also included that of a locally forming post-operative tender granuloma and the remote possibility of an incisional endometrioma (although no link to menstruation could be made). Local malignancy was not taken as a serious possibility. Definitive diagnosis of the excised lesion was made at histology. The pre-operative diagnostic dilemma is presented, along with a short review of the literature.
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Affiliation(s)
- Christos Simoglou
- Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
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95
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Francica G. Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar. World J Radiol 2012; 4:135-40. [PMID: 22590667 PMCID: PMC3351681 DOI: 10.4329/wjr.v4.i4.135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/23/2012] [Accepted: 03/30/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features.
METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases.
RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04).
CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.
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96
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Uysal A, Mun S, Taner CE. Endometrioma in abdominal scars: case reports of four cases and review of the literature. Arch Gynecol Obstet 2012; 286:805-8. [PMID: 22476380 DOI: 10.1007/s00404-012-2320-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/26/2012] [Indexed: 12/20/2022]
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97
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98
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Savelli L, Manuzzi L, Di Donato N, Salfi N, Trivella G, Ceccaroni M, Seracchioli R. Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:336-340. [PMID: 21793086 DOI: 10.1002/uog.10052] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe the sonographic and clinical features of abdominal wall endometriosis (AWE), a frequently misdiagnosed condition. METHODS This was a retrospective study of 21 consecutive women with pathologically proven endometriosis of the abdominal wall. Ultrasonographic and Doppler examinations were performed, before surgery, with a high-frequency linear transducer. The clinical data and the results of the sonographic examinations were reviewed and described. RESULTS At ultrasound, all the nodules appeared as discrete solid masses that were less echogenic than the surrounding hyperechoic fat. The nodules had a median diameter of 20 (range, 5-50) mm and in 18/21 (86%) cases the nodules had a round/oval shape. In eight of 21 (38%) women the AWE was located at the umbilicus, in six of 21 (29%) it was between the transverse suprapubic line and the umbilicus, in five of 21 (24%) it was found along the scar of a previous Cesarean section and in two of 21 (9%) it was in the right inguinal canal. The content was homogeneously hypoechoic in 12/21 (57%) women and inhomogeneous in the other nine (43%). The outer borders were invariably ill defined. Scarce blood vessels were found by power Doppler. Cyclic or continuous spontaneous pain at the level of the AWE was present in 19/21 (91%) cases, and two (9%) patients were asymptomatic. CONCLUSIONS Hypoechoic round/oval nodules with ill-defined borders and a hyperechoic rim should raise the suspicion of abdominal wall endometriosis, even in patients with no history of endometriosis or previous laparotomic surgery. Pressing the ultrasound probe against the nodule should reinforce a suspected diagnosis because of the pain it induces.
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Affiliation(s)
- L Savelli
- Gynecology and Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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99
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Kim JY, Kwon JE, Kim HJ, Park K. Fine-needle aspiration cytology of abdominal wall endometriosis: a study of 10 cases. Diagn Cytopathol 2011; 41:115-9. [PMID: 21987456 DOI: 10.1002/dc.21779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/31/2011] [Accepted: 06/12/2011] [Indexed: 11/09/2022]
Abstract
While about 15% of menstruating women develop endometriosis, abdominal wall endometriosis is relatively rare. We present 10 cases of abdominal wall endometriosis diagnosed by fine-needle aspiration (FNA) cytology and confirmed by subsequent surgical excision. A palpable abdominal wall mass was the most common symptom, followed by pain. Nine cases were associated with previous surgery. The smear showed glandular epithelial cells and spindle or ovoid stromal cells accompanied by macrophages in eight cases. The nucleus was round-to-oval and the nucleolus was inconspicuous. Mitosis was not observed in any case. In two cases, which were suspicious of malignancy on FNA, the epithelial cells showed anisonucleosis, hyperchromasia, and small conspicuous nucleoli. The stromal cells were spindle or ovoid in shape, without metaplastic changes. Histiocytes were noted in nine cases and hemosiderin-laden histiocytes were noted in two cases. The proportion of inflammatory cells varied. FNA diagnosis of abdominal wall endometriosis is possible when the cytological features are interpreted cautiously, together with the patient's clinical history. An accurate diagnosis on FNA will prevent unnecessary surgery.
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Affiliation(s)
- Jung Yeon Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea.
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100
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Abstract
Endometriosis is the presence of functioning endometrium outside the uterus. Endometriosis rarely occurs in the abdominal wall. Majority of abdominal wall endometriosis occur in or adjacent to surgical scars, following caesarean section or hysterectomy. Laparotomy scar endometriosis following salpingectomy for ectopic pregnancy has rarely been reported. We report a case of scar endometriosis following laparotomy for chronic ectopic, and diagnosed by fine needle aspiration cytology (FNAC). Excision biopsy confirmed the FNAC diagnosis of scar endometriosis.
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