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Neme GL, Guimarães CTS, Dantas PP, Santana DDB, Yamauchi FI, Filho HML, Bittencourt LK, Pereira RMA, Mattos LA. Postoperative Imaging of Endometriosis. Radiographics 2024; 44:e230159. [PMID: 38512726 DOI: 10.1148/rg.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Glaucy L Neme
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Patricia P Dantas
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Daniel D B Santana
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Fernando I Yamauchi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Hilton M Leão Filho
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leonardo K Bittencourt
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Ricardo M A Pereira
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leandro A Mattos
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
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Haghgoo A, Faegh A, Mostafavi SRS, Zamani HR, Ghahremani M. Inguinal endometriosis: a case series and review of the literature. J Med Case Rep 2024; 18:83. [PMID: 38429816 PMCID: PMC10908077 DOI: 10.1186/s13256-024-04400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. CASE PRESENTATION 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. CONCLUSION According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery.
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Affiliation(s)
- Ameneh Haghgoo
- School of Medicine, Nikan Hospital, Iran University of Medical Sciences, Aqdasiyeh, Army Boulevard, 22nd Bahman Street, Tehran, Iran.
| | - Ali Faegh
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Hamid Reza Zamani
- Department of Radiology, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bindra V, Nori M, Reddy R, Reddy R, Satpathy G, Reddy CA. Sciatic nerve endometriosis - The correct approach matters: A case report. Case Rep Womens Health 2023; 38:e00515. [PMID: 37275569 PMCID: PMC10238457 DOI: 10.1016/j.crwh.2023.e00515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Abstract
Endometriosis is a chronic inflammatory condition affecting nearly 10-15% of women of reproductive age and most frequently occurs in the pelvis. Extrapelvic endometriosis leading to sacral neuropathy is rare. A 29-year old woman, para 1 (vaginal delivery 8 years previously), presented with worsening right hip and buttock pain radiating to the right leg, resulting in limping and other gait changes due to delayed diagnosis and treatment. A diagnosis of sciatic nerve endometriosis was made based on both clinical and imaging findings. The final diagnosis was confirmed on histopathological examination. Transgluteal excision of the sciatic nerve with concomitant laparoscopy for exploration of the pelvic part of the sciatic nerve and excision of the pelvic endometriosis were undertaken. The operating team included a gynaecologist, an orthopaedic surgeon and a neurosurgeon. Postoperative recovery was uneventful and physiotherapy was started. Pain and gait improved. Endometriosis of the sciatic nerve should be suspected if a patient complains of cyclical sciatica. Magnetic resonance remains the imaging modality of choice. This case report illustrates the benefit of a multidisciplinary approach.
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Affiliation(s)
- Vimee Bindra
- Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
| | | | | | | | | | - C. Archana Reddy
- Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
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Tilva H, Tayade S, Kanjiya A. Contemporary Review of Masses in the Canal of Nuck. Cureus 2023; 15:e36722. [PMID: 37123808 PMCID: PMC10130799 DOI: 10.7759/cureus.36722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Canal of Nuck masses is a rare occurrence that can cause swelling in the abdominal-inguinal region of females for various reasons. This condition arises due to an abnormal persistence of the processus vaginalis opening. Although Canal of Nuck pathology is not widely known among general surgeons or gynecologists due to its rarity, it has been associated with significant morbidity and requires further research. In this comprehensive review, we aim to summarize the embryology and anatomy of the Canal of Nuck, followed by a description of the various types of masses that can occur in this region. We discuss the clinical presentation and diagnostic workup of Canal of Nuck masses, including imaging modalities and differential diagnoses. Next, we review the surgical management of these masses, including open and laparoscopic approaches. Finally, we discuss the potential complications and long-term outcomes associated with Canal of Nuck pathology. This review aims to compile the presently accessible literature on anomalies occurring in the Canal of Nuck in females, with a particular focus on describing their pathological nature, diagnosis, and management. In summary, this review provides an up-to-date understanding of the pathology, diagnosis, and management of Canal of Nuck masses and aims to raise awareness of this under-recognized surgical challenge among healthcare providers.
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Pseudomyxoma peritonei involving the canal of Nuck: The added value of magnetic resonance imaging for detection and presurgical planning. Radiol Case Rep 2022; 17:1887-1889. [PMID: 35401905 PMCID: PMC8990032 DOI: 10.1016/j.radcr.2022.03.011] [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] [Received: 01/05/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
The canal of Nuck is an abnormal patent pouch of the parietal peritoneum caused by the incomplete obliteration of the processus vaginalis in females. The most common disorders of the canal of Nuck are: hernia, hydrocele and endometriosis. Pseudomyxoma Peritonei (PMP) is a clinical condition characterized by the accumulation of mucinous material on the surfaces and in the recesses of the peritoneal cavity, resulting from the perforation of an appendiceal mucinous neoplasm. We report the case of a young woman with a clinical history of chronic pelvic pain and infertility who was referred to our center after being diagnosed with appendiceal mucinous neoplasm and PMP. MRI staging examination revealed the right canal of Nuck filled with mucinous material, which was confirmed at surgery. The involvement of canal of Nuck is extremely rare in PMP. MRI provides a sensitive imaging modality for appropriate preoperative planning of PMP and helps surgeons identify uncommon disease sites such such as the canal of Nuck in women, which, if missed, may prevent complete cytoreductive surgery.
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Comparison of Isolated Sciatic Nerve and Sacral Nerve Root Endometriosis: A Review of the Literature. J Minim Invasive Gynecol 2022; 29:943-951. [DOI: 10.1016/j.jmig.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Maeda M, Hisa T, Matsuzaki S, Ohe S, Nagata S, Lee M, Mabuchi S, Kamiura S. Primary Fallopian Tube Carcinoma Presenting with a Massive Inguinal Tumor: A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58050581. [PMID: 35629998 PMCID: PMC9147285 DOI: 10.3390/medicina58050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Primary fallopian tube carcinoma (PFTC) has characteristics similar to those of ovarian carcinoma. The typical course of PFTC metastasis includes peritoneal dissemination and pelvic and paraaortic lymph node metastasis, while inguinal lymph node metastasis is rare. Moreover, the initial presentation of PFTC with an inguinal tumor is extremely rare. A 77-year-old postmenopausal woman presented with a massive 12-cm inguinal subcutaneous tumor. After tumor resection, histopathological and immunohistochemical analysis showed that the tumor was a high-grade serous carcinoma of gynecological origin. Subsequent surgery for total hysterectomy with bilateral salpingo-oophorectomy revealed that the tumor developed in the fallopian tube. She received adjuvant chemotherapy with carboplatin and paclitaxel, followed by maintenance therapy with niraparib. There has been no recurrence or metastasis 9 months after the second surgery. We reviewed the literature for cases of PFTC and ovarian carcinoma that initially presented with an inguinal tumor. In compliance with the Preferred Reporting Items for Systematic Reviews guidelines, a systematic literature search was performed through 31 January 2022 using the PubMed and Google scholar databases and identified 14 cases. In half of them, it was difficult to identify the primary site using preoperative imaging modalities. Disease recurrence occurred in two cases; thus, the prognosis of this type of PFTC appears to be good.
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Affiliation(s)
- Michihide Maeda
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan; (M.M.); (T.H.); (S.M.); (S.M.)
| | - Tsuyoshi Hisa
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan; (M.M.); (T.H.); (S.M.); (S.M.)
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan; (M.M.); (T.H.); (S.M.); (S.M.)
| | - Shuichi Ohe
- Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan;
| | - Shigenori Nagata
- Department of Clinical Pathology, Osaka International Cancer Institute, Osaka 541-8567, Japan;
| | - Misooja Lee
- Department of Forensic Medicine, School of Medicine, Kindai University, Osaka 589-8511, Japan;
| | - Seiji Mabuchi
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan; (M.M.); (T.H.); (S.M.); (S.M.)
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan; (M.M.); (T.H.); (S.M.); (S.M.)
- Correspondence: ; Tel.: +81-6-6945-1181; Fax: +81-6-6945-1929
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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: 2] [Impact Index Per Article: 0.7] [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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Parillo M, Altomare C, Bianchi A, Beomonte Zobel B, De Cicco Nardone C, Quattrocchi CC. A rare case of left Nuck’s canal cystic endometriosis: Computed Tomography findings. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211037235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain. Case description: A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall. Conclusion: In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Altomare
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonella Bianchi
- Unit of Pathology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo De Cicco Nardone
- Unit of Ginecology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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How embryology knowledge can help radiologists in the differential diagnosis of canal of Nuck pathologies. Radiol Med 2021; 126:910-924. [PMID: 33954897 DOI: 10.1007/s11547-021-01361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The Canal of Nuck (CN) is an anatomical structure which is often forgotten. It is the female equivalent of the male processus vaginalis and corresponds to a protrusion of parietal peritoneum that extends from the inguinal canal to labia majora. Radiologists rarely encounter patients with pathology of CN, especially in adult population. It is well known that CN diseases can occur in paediatric patient (especially younger than 5 years of age) and they are associated to high morbidity (for example ovarian hernia with high risk of incarceration and torsion). The aim of our work is to review embryology, anatomy and pathologies of the CN thanks to a multi modal approach-ultrasound (US), Computed Tomography (CT) and Magnetic Resonance imaging (MRI)-to make radiologists more aware of such conditions and guarantee a prompt and correct diagnosis not only in paediatric patients but also in the adult population.
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11
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Chen PC, Cheng CH, Ding DC. Primary inguinal subcutaneous endometriosis accompanied with an inguinal hernia: A case report. Medicine (Baltimore) 2021; 100:e25460. [PMID: 33832157 PMCID: PMC8036060 DOI: 10.1097/md.0000000000025460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE We report a case with inguinal subcutaneous endometriosis without typical cyclic dysmenorrhea and accompanied with a hernia sac treated with resection of the tumor and herniorrhaphy. PATIENT CONCERNS A 40-year-old woman had a painless enlarged inguinal nodule for 3 months. DIAGNOSES Subcutaneous endometriosis accompanied with a hernia sac. INTERVENTIONS Ultrasonography showed a hypoechoic lesion (3.0 cm × 2.0 cm), and an inguinal subcutaneous tumor was first suspected. After surgical exploration, a cystic lesion was excised and the hernia hole was repaired by herniorrhaphy. The immunohistochemical analysis of the small endometriotic cyst-like lesion revealed calretinin (-) in epithelial cells and CD10 (+) in stromal cells, indicative of subcutaneous endometriosis accompanied with a hernia sac. OUTCOMES The patient was followed up for 1 year and without recurrence. LESSONS Cutaneous endometriosis accompanied with a hernia sac can be presented without typical endometriosis-associated symptoms such as dysmenorrhea. Inguinal endometriosis might be the differential diagnosis of inguinal painless nodules.
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Affiliation(s)
| | - Chiu-Hsuan Cheng
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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12
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Prodromidou A, Pandraklakis A, Rodolakis A, Thomakos N. Endometriosis of the Canal of Nuck: A Systematic Review of the Literature. Diagnostics (Basel) 2020; 11:diagnostics11010003. [PMID: 33375037 PMCID: PMC7821999 DOI: 10.3390/diagnostics11010003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a common benign gynecological condition defined as the presence of endometrial tissue in tissues outside the uterine cavity. Apart from the common sites of endometriosis, rare sites other have also been reported including the liver, the thoracic cavity, the muscles, nerves, and more rarely in a patent Nuck canal. We aim to evaluate the clinical presentation, diagnostic features, and management of the Nuck endometriosis. A meticulous search of three electronic databases was performed until May 2020 for articles reporting cases of Nuck endometriosis. A total of 36 patients from 20 studies were analyzed. Median age of patients was 36 years with 33 women being of reproductive age. A right-sided lesion was identified in 30 cases (83.3%), while all patients suffer from a groin mass with cyclic pain in a proportion of 22%. All the patients finally underwent surgery for investigation of the lesion and fixation of the defect. Five cases of malignancy were detected at final pathology. All of them were alive with a median reported overall survival of 37 months. Nuck endometriosis should be included in the differential diagnosis of female patients with groin swelling. An evaluation by a gynecologist is important when endometriosis is suspected.
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Gandhi J, Wilson AL, Liang R, Weissbart SJ, Khan SA. Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520970813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometriosis is a condition in which there is an ectopic growth of endometrial tissue. Sciatic endometriosis, otherwise known as catamenial sciatica, is a rare but exceedingly significant presentation of endometriosis. Symptoms include cyclic sciatic pain that peaks during the menstrual period; additionally, paresthesia, paresis, and areflexia may occur with this condition. Sciatic endometriosis can be presumptively diagnosed in response to empiric treatment (e.g. gonadotropin-releasing hormone analogs) or imaging studies, but a definitive diagnosis of sciatic endometriosis may occur from examining tissue obtained during surgery. Surgical removal of endometriosis from the sciatic nerve root can potentially eliminate symptoms while maintaining normal reproductive function, though poses particular surgical risks. Familiarity with this rare condition is paramount to making this diagnosis and the initiation of earlier treatment.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Medical Student Research Institute, St. George’s University School of Medicine, Grenada, West Indies
| | - Anthony L Wilson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raymond Liang
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Steven J Weissbart
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Women’s Pelvic Health & Continence Center, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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14
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Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol 2020; 19:323-333. [PMID: 33071634 PMCID: PMC7542014 DOI: 10.1002/rmb2.12340] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extra-pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra-pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE). METHODS The authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra-pelvic endometriosis. MAIN FINDINGS Abdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis-related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP. CONCLUSION Evidence-based approaches to diagnosis and treatment of extra-pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra-pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and GynecologyDoai Kinen HospitalSumida‐kuJapan
- Faculty of MedicineDepartment of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kaori Koga
- Faculty of MedicineDepartment of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Yutaka Osuga
- Faculty of MedicineDepartment of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
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15
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Endometriosis of the Canal of Nuck—an Unusual Case of Inguinal Swelling. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Jha P, Sakala M, Chamie LP, Feldman M, Hindman N, Huang C, Kilcoyne A, Laifer-Narin S, Nicola R, Poder L, Shenoy-Bhangle A, Tong A, VanBuren W, Taffel MT. Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020; 45:1552-1568. [PMID: 31728612 DOI: 10.1007/s00261-019-02291-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of involvement. The Society of Abdominal Radiology's Endometriosis Disease-Focused Panel presents this consensus document to establish an MRI lexicon for endometriosis MRI evaluation and anatomic localization.
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Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA, USA.
| | - Michelle Sakala
- Department of Radiology, Michigan Medicine (University of Michigan), Ann Arbor, MI, USA
| | - Luciana Pardini Chamie
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Myra Feldman
- Cleveland Clinic Imaging Institute, Cleveland, OH, USA
| | - Nicole Hindman
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Chenchan Huang
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sherelle Laifer-Narin
- Department of Radiology, Columbia University / New York Presbyterian Hospital, New York, NY, USA
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, NY, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA, USA
| | - Anuradha Shenoy-Bhangle
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Angela Tong
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Wendy VanBuren
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Myles T Taffel
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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17
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Hydrocele of the Canal of Nuck with Endometriosis: Right-Side Dominance Confirmed by Literature Review and Statistical Analysis. Case Rep Pathol 2020; 2020:2567267. [PMID: 32695544 PMCID: PMC7368960 DOI: 10.1155/2020/2567267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction. The canal of Nuck is an embryological remnant of the peritoneal pouch that extends into the labium majus of women. Hydrocele is the most common presentation, but only a small number of cases are reported in association with endometriosis. Case Presentation. The patient is a 45-year-old woman who presented with left inguinal mass with persistent pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 30 mm cystic mass, and a hydrocele of the canal of Nuck (HCN) was suspected. The excised mass was a cyst containing yellow-tan serous fluid, and the cyst wall was lined by mesothelium. The morphology was consistent with conventional HCN. However, since several foci of endometrial-like epithelium and stroma were identified beneath the mesothelium, the mass was diagnosed with HCN with endometriosis (EM-HCN). Discussion. Right-side dominance of EM-HCN is suggested by several authors, but a thorough review has never been performed. For the first time, we reviewed the literature and statistically confirmed that EM-HCNs dominantly occur on the right side compared to those without endometriosis. We consider that this supports the theory that endometriosis derives from retrograde menstruation of endometrial tissue through fallopian tubes. When endometriosis is discovered in HCN, the clinician should be aware of the possibility of pelvic endometriosis.
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18
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Brainwood M, Beirne G, Fenech M. Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 2020; 23:22-29. [PMID: 34760578 DOI: 10.1002/ajum.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The processus vaginalis is a blind-ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.
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Affiliation(s)
- Michelle Brainwood
- Department of Ultrasound Qscan Radiology Clinics College Junction 2-12 Wagner Road Clayfield Queensland 4011 Australia
| | - Geraldene Beirne
- Locum Senior Sonographer Matraville New South Wales 2036 Australia
| | - Michelle Fenech
- School of Health, Medical and Applied Sciences Central Queensland University 160 Ann Street Brisbane Queensland 4000 Australia
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19
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Togashi K, Ooyama N, Enomoto K, Sato H. A case report of advanced ovarian cancer detected due to an inguinal metastasis in the canal of Nuck. Int J Surg Case Rep 2019; 66:277-282. [PMID: 31884264 PMCID: PMC6939067 DOI: 10.1016/j.ijscr.2019.12.021] [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] [Received: 10/15/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Ovarian cancer has few subjective symptoms, so approximately 40%-50% of cases have already reached stage III or IV by the time of diagnosis. These are advanced stages of the disease and have poor prognosis. Among these cases, less than 3 % are reported to exhibit inguinal lymph node metastasis. This report documents a rare case of advanced ovarian cancer that we detected due to an inguinal metastasis in the canal of Nuck. The work has been reported in line with the SCARE criteria. PRESENTATION OF CASE The patient was a 43-year-old, married, premenopausal woman (G2P1). She was examined by her local practitioner for a chief complaint of a mass in the right inguinal region and was found to have a right inguinal mass. Magnetic resonance imaging (MRI) scans revealed a left ovarian tumor, and she was referred to our department. Rapid intraoperative diagnosis showed a highly atypical serous carcinoma present in both the left ovary and the right inguinal region mass, where the tumor had extended into the canal of Nuck. DISCUSSION In this case, the right inguinal mass was ovarian cancer that had metastasized to a cyst in the canal of Nuck via the round ligament of the uterus. Though, many adult women with these types of inguinal hydrocoeles sometimes undergo fine-needle aspiration. CONCLUSION This finding may highlight the need for a careful search for metastasis to the inguinal region in cases of ovarian cancer.
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Affiliation(s)
- Kazue Togashi
- Department of Obstetrics and Gynecology, Japanese Red Cross Akita Hospital, Akita, Japan; Department of Obstetrics and Gynecology, Akita University Hospital, Akita, Japan.
| | - Noriaki Ooyama
- Department of Obstetrics and Gynecology, Japanese Red Cross Akita Hospital, Akita, Japan
| | - Katsuhiko Enomoto
- Department of Pathology, Japanese Red Cross Akita Hospital, Akita, Japan
| | - Hirokazu Sato
- Department of Obstetrics and Gynecology, Japanese Red Cross Akita Hospital, Akita, Japan
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20
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Extrapelvic Sciatic Nerve Endometriosis, the Role of Magnetic Resonance Imaging: Case Report and Systematic Review. J Comput Assist Tomogr 2019; 43:976-980. [PMID: 31688247 DOI: 10.1097/rct.0000000000000916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.
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21
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Fong KNY, Lau TWS, Mak CCC, Lui KW. Inguinal endometriosis: a differential diagnosis of right groin swelling in women of reproductive age. BMJ Case Rep 2019; 12:12/8/e229864. [PMID: 31451459 DOI: 10.1136/bcr-2019-229864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We reported a case of right inguinal endometriosis in a 41-year-old woman with unremarkable surgical and gynaecological history. She presented with right groin swelling for a month since her last menstrual period. Clinically the swelling was first diagnosed as inguinal hernia and later histologically proven to be endometriosis.
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Affiliation(s)
| | | | | | - Ka Wing Lui
- Department of Surgery, Yan Chai Hospital, Hong Kong
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22
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Arakawa T, Hirata T, Koga K, Neriishi K, Fukuda S, Ma S, Sun H, Nagashima N, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Clinical aspects and management of inguinal endometriosis: A case series of 20 patients. J Obstet Gynaecol Res 2019; 45:2029-2036. [PMID: 31381248 DOI: 10.1111/jog.14059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/23/2019] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to describe the clinical presentation, diagnostic evaluation, and operative or medical management of inguinal endometriosis. METHODS In this study, we retrospectively reviewed 20 cases of inguinal endometriosis in our facility, particularly on the clinical characteristics, diagnosis, and surgical and medical treatment. RESULTS We retrospectively investigated the following items for each patient: age at diagnosis, surgical history, presence of extragenital endometriosis, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence and time to recurrence. We identified 20 cases of inguinal endometriosis in our facility. First, 75% of the patients had right inguinal endometriosis. Second, T1-weighted or fat-saturated T1-weighted images showed hyperintensity in the lesions in 17 patients (17/18 patients, 94.4%). Third, in 5 of 6 patients who underwent surgical therapy, we performed radical surgery to excise the inguinal lesion including the round ligament. One patient had disease relapse. Fourth, in 6 of 7 cases, dienogest effectively improved pain without significant adverse effects, but oral contraceptive was effective in 1 of 4 patients without significant adverse effects. CONCLUSION We retrospectively reviewed 20 patients with inguinal endometriosis in our facility. We have shown that magnetic resonance imaging can be a useful imaging modality to obtain a specific diagnosis of this disease. In addition, inguinal endometriosis can be managed with radical surgery to resect lesions including the round ligament and with hormonal treatment. In particular, dienogest ameliorated symptoms, which can be an option for patients who do not want surgery.
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Affiliation(s)
- Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Suke Ma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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23
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Abstract
Endometriosis is a common disease of reproductive-age women that is often first encountered with ultrasound. Therefore, familiarity with the variety of manifestations of endometriosis is important for appropriate diagnosis and management. The aim of this article is to review the spectrum of appearance of pelvic endometriosis and to discuss potential mimics on ultrasound. Given that magnetic resonance imaging is an important problem-solving tool in female pelvic imaging, magnetic resonance imaging correlation is also provided.
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24
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Wolfhagen N, Simons NE, de Jong KH, van Kesteren PJM, Simons MP. Inguinal endometriosis, a rare entity of which surgeons should be aware: clinical aspects and long-term follow-up of nine cases. Hernia 2018; 22:881-886. [PMID: 30078093 DOI: 10.1007/s10029-018-1797-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inguinal endometriosis is a rare disease and often misdiagnosed for other, more common groin pathology. We present nine cases of women with inguinal endometriosis with long-term follow-up. METHODS In this retrospective case series, the Dutch PALGA system was searched for all patients diagnosed with extrapelvic endometriosis located in the groin in the OLVG hospital, Amsterdam, between 2000 and 2016. Relevant information regarding pre- and postoperative characteristics and symptoms was collected. Follow-up consisted of a telephone call from the attending surgeon. RESULTS None of the patients had a history of pelvic endometriosis. Typically, they presented with a right-sided swelling in the groin. Preoperative ultrasound and MRI were in most cases inconclusive. In one of two patients fna indicated endometriosis. In only three patients the surgeon considered the diagnosis endometriosis preoperatively. Surgical removal was effective with no reported complications. A coexisting hernia sac was resected in four cases, and there was a suspicion of a persistent processus vaginalis (canal of Nuck) in three, suggesting that a persistent processus vaginalis is possibly an important key to the pathogenesis. In none of the cases there was an indication for mesh implantation. One patient was later diagnosed with pelvic endometriosis. CONCLUSION Follow-up by a gynecologist is advised to check for intra-abdominal disease and inform patients on fertility perspective. Surgeons should be aware of the possibility of inguinal endometriosis in fertile women with a lump in the groin.
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Affiliation(s)
- N Wolfhagen
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - N E Simons
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - K H de Jong
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P J M van Kesteren
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
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25
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Nasser H, King M, Rosenberg HK, Rosen A, Wilck E, Simpson WL. Anatomy and pathology of the canal of Nuck. Clin Imaging 2018; 51:83-92. [PMID: 29448124 DOI: 10.1016/j.clinimag.2018.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/17/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it.
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Affiliation(s)
- Hussein Nasser
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Michael King
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | | | - Ally Rosen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Eric Wilck
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - William L Simpson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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26
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Matsumoto T, Hara T, Hirashita T, Kubo N, Hiroshige S, Orita H. Laparoscopic diagnosis and treatment of a hydrocele of the canal of Nuck extending in the retroperitoneal space: A case report. Int J Surg Case Rep 2014; 5:861-4. [PMID: 25462052 PMCID: PMC4245671 DOI: 10.1016/j.ijscr.2014.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/19/2014] [Accepted: 08/16/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hydrocele of the canal of Nuck is a rarely encountered entity. We report a case underwent laparoscopic totally extraperitoneal (TEP) treatment for a hydrocele of the canal of Nuck extending in the extraperitoneal space mainly. PRESENTATION OF CASE A 37-year-old woman complained of painless and reducible swelling in her left groin, and referred to our hospital for surgical management against left inguinal hernia with the incarcerated ovary. Ultrasonography and MR images revealed a cystic mass in the retroperitoneal space, and we diagnosed as an unusual type of hydrocele of the canal of Nuck. The patient was scheduled for laparoscopic treatment. Laparoscopic findings on pneumoperitoneum showed an extraperitoneal cystic tumor with no contact with the left ovary. The fascia and peritoneum of the port site were closed, and then an extraperitoneal space was created. The cystic tumor with the round ligament of the uterus was dissected and resected by the TEP technique. The extended deep inguinal ring was repaired with polypropylene mesh. Postoperative course was uneventful. DISCUSSION Hydrocele of the canal of Nuck in the adult female is a rare condition. The accurate diagnosis of an inguinal hydrocele in a female is seldom made. Laparoscopic examination provides surgeons with information of inguinal swelling accompanied with retroperitoneal cyst, and consecutive treatment by laparoscopic technique, especially TEP, is useful in regard to minimal damage of the peritoneum. CONCLUSION Laparoscopic diagnosis and TEP treatment offers a useful alternative in selected patients with hydrocele of the canal of Nuck.
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Affiliation(s)
- Toshifumi Matsumoto
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
| | - Takao Hara
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Teijiro Hirashita
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Nobuhide Kubo
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Shoji Hiroshige
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Hiroyuki Orita
- Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan
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27
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Pahwa AK, Siegelman ES, Arya LA. Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review. Clin Anat 2014; 28:305-13. [PMID: 25256076 DOI: 10.1002/ca.22472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/08/2014] [Accepted: 08/28/2014] [Indexed: 11/11/2022]
Abstract
Pelvic organ prolapse, a herniation of pelvic organs through the vagina, is a common condition in older women. Pelvic organ prolapse distorts vaginal anatomy making pelvic examination difficult. A clinician must accurately identify anatomic landmarks both in women presenting with symptoms of prolapse and in women noted to have coincidental prolapse during routine gynecologic examination. We present a systematic approach to the female pelvic examination including anatomic landmarks of the external genitalia, vagina, and uterus in women with normal support as well as changes that occur with pelvic organ prolapse. Knowledge and awareness of normal anatomic landmarks will improve a clinician's ability to identify defects in pelvic support and allow for better diagnosis and treatment of pelvic organ prolapse.
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Affiliation(s)
- Avita K Pahwa
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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28
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Abstract
BACKGROUND A cyst of the canal of Nuck is a rare cause of inguinal swelling in adult women. Ectopic pregnancies that implant to rare regions are sometimes challenging to diagnose. CASE A 45-year-old woman presented with painful swelling in her right groin with a positive urine pregnancy test. Ultrasonography, magnetic resonance imaging, and the histopathologic result of dilation and curettage suggested ectopic pregnancy in the right inguinal canal. Exploratory laparotomy, extraction of the right inguinal mass lesion, and closure of the deep inguinal ring were performed. The mass lesion measured 4×3 cm, and the histopathologic finding revealed an unusual ectopic pregnancy in the cyst of the canal of Nuck. CONCLUSION In women of reproductive age presenting with painful swelling of the groin, ectopic pregnancy in a cyst of the canal of Nuck should be ruled out.
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29
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Inguinal endometriosis in a patient without a previous history of gynecologic surgery. Obstet Gynecol Sci 2014; 57:172-5. [PMID: 24678494 PMCID: PMC3965704 DOI: 10.5468/ogs.2014.57.2.172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/01/2013] [Accepted: 09/16/2013] [Indexed: 11/13/2022] Open
Abstract
Endometriosis, defined as growth of endometrial stroma and glands outside the uterine cavity, is a chronic and recurrent disease that affects patients' quality of life. Ectopic endometrial tissue can proliferate at any location in the body, but the pelvic organs and peritoneum are the most frequent implantation sites. Among extrapelvic endometriosis, inguinal endometriosis is a very rare gynecologic condition usually associated with previous pelvic surgery. Endometriosis should be preoperatively distinguished from other inguinal masses using computed tomography, magnetic resonance imaging, or ultrasonography. Here, we report a case of right inguinal endometriosis in a patient with no previous history of gynecologic surgery; in addition, we have provided a brief review of relevant literature.
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30
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Bianek-Bodzak A, Szurowska E, Sawicki S, Liro M. The importance and perspective of magnetic resonance imaging in the evaluation of endometriosis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:436589. [PMID: 24350271 PMCID: PMC3854449 DOI: 10.1155/2013/436589] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/09/2013] [Accepted: 09/27/2013] [Indexed: 12/20/2022]
Abstract
MR imaging is becoming increasingly important in the assessment of patients with endometriosis. Its multiplanar capabilities and superior soft tissue contrast are particularly useful in the detection of deep infiltrating endometriotic implants. Endometriosis, defined as the presence of endometrial glands and stroma outside the endometrium, is among the most common gynaecological disorders affecting women in their reproductive age. The diagnosis and evaluation of the extension of endometriosis are difficult only with physical examination and laparoscopy. According to the authors' personal experience, a special MRI technique and some imaging guidelines regarding different anatomical localizations of endometriosis are discussed. This review is a brief presentation of current evidence on the diagnostic accuracy of MRI in the evaluation of endometriosis concerning other diagnostic methods, the limitations of MRI and its essential usefulness for preoperative diagnosis of deep pelvic endometriosis, and future perspectives in monitoring this disease.
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Affiliation(s)
| | - Edyta Szurowska
- The Second Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Sambor Sawicki
- Department of Gynaecology, Medical University of Gdansk, Kliniczna 1 A, 80-402 Gdansk, Poland
| | - Marcin Liro
- Department of Gynaecology, Medical University of Gdansk, Kliniczna 1 A, 80-402 Gdansk, Poland
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Potential mechanisms of postmenopausal endometriosis. Maturitas 2012; 72:214-9. [DOI: 10.1016/j.maturitas.2012.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/24/2012] [Indexed: 01/24/2023]
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Giusti S, Forasassi F, Bastiani L, Cela V, Pluchino N, Ferrari V, Fruzzetti E, Caramella D, Bartolozzi C. Anatomical localization of deep infiltrating endometriosis: 3D MRI reconstructions. ACTA ACUST UNITED AC 2012; 37:1110-21. [DOI: 10.1007/s00261-012-9848-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:301-5. [PMID: 21734502 DOI: 10.1097/gco.0b013e3283491e27] [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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