Cutaneous endometriosis: review of 15 cases diagnosed at a single institution

Primary umbilical endometriosis: Surgical case report

Introduction

Endometriosis is a benign nevertheless a chronic condition which impacts greatly the quality of life through cyclic discomfort. We aim to report the case of umbilical endometriosis and a literature review of the different treatment modalities.

Case Report

This was a case of a 43-year-old woman, with no history, who presented with a painful hemorrhagic umbilical swelling during the menstrual period associated with dysmenorrhea. Abdominal ultrasound revealed a subcutaneous umbilical mass of non-vascularized tissue nature confirmed on Doppler. Pelvic MRI which confirms the diagnosis of primary umbilical endometriosis. The patient underwent wide local excision of the endometriotic nodule with umbilical reconstruction. Histology confirmed the diagnosis of umbilical endometriosis. Resection margins were clear.

Discussion

Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. Surgical management is currently described as gold standard. Laparoscopic approach is recommended as it allows better visual inspection for secondary localization of endometriosis. Medical management corresponds to combined oral contraceptives (COCs) or progestins for management of endometriotic implants decreasing inflammatory effects, or Gonadotropin-releasing hormone for long-course treatment. Malignant transformation of the umbilical nodule has been described in literature with a reported risk of malignant transformation to be 3%.

Conclusion

Current management of extragenital endometriosis suggest radical surgery with wide local excision. Due to the rarity, there is a paucity of data on umbilical endometriosis and mostly reported from case reports.

Primary Subcutaneous Umbilical Endometriosis: Case Report and Review of the Literature

We report the case of a patient diagnosed with primary umbilical endometriosis intending to discuss the diagnostic and therapeutic management of this rare disease. A 45-year-old woman suffering from a painful swelling located in the umbilical region, with intact and normal cutaneous aspect, came to our attention. Ultrasonography of the umbilical region showed a nodule with a nonhomogeneous echotexture pattern. Partial omphalectomy was performed under local anesthesia in day care setting surgery. Histology confirmed the diagnosis of umbilical endometriosis. Pre- and postoperative clinical controls showed no evidence for other endometriosis localization. No medical treatment was administered. No signs of recurrence were observed after 5 years from surgery. A review of the literature of the last 10 years was generated based on MEDLINE research, selecting some specific keywords. Several lesions can occur in the umbilical region, and endometriosis has to be ruled out even in patients without any surgery in their medical history. Surgery is the gold standard treatment for this condition: partial and radical omphalectomy are the two treatment options. We believe that given the significant psychological and aesthetical value of the umbilicus, surgical treatment has to be tailored and in case of a small endometrial umbilical nodule, partial omphalectomy (local excision of the umbilical endometrial nodule) with a 3 mm free border, even without adjuvant hormonal treatment, could ensure adequate and effective treatment.

Postmenopausal Spontaneous Umbilical Endometriosis: A Case Report

Endometriosis is a benign gynecologic disease that highly influences women of childbearing age. It is characterized by ectopic endometrial tissue. Primary umbilical endometriosis is a rare condition. It is a benign disease with endometrial tissue in an abnormal site in the navel. It may be accompanied with pain in the navel and a discolored bump. Among all locations with the potential for endometriosis, the navel has less than 1% incidence of primary umbilical endometriosis. In the present study, we reported a rare case of umbilical endometriosis revealed via a biopsy performed for a 49-year-old menopausal woman with the complaint of pain in the navel who underwent surgical excision and a biopsy after a scan.

Endometriosis de la pared abdominal: estudio descriptivo de una serie de 21 casos

Introducción. La endometriosis de la pared abdominal se define como la presencia de tejido endometrial en cualquiera de las capas que componen la pared abdominal. Su incidencia es baja y se caracteriza por un diagnóstico tardío. Materiales y métodos. Se trata de un estudio descriptivo y ambiespectivo entre 2010 y 2014 en pacientes con endometriosis de la pared abdominal, cuyo análisis patológico fue realizado en un centro de ayudas diagnósticas de Medellín. Se identificaron las variables histopatológicas del reporte, y la información clínica mediante una entrevista telefónica suministrada por la paciente. Se analizaron los datos con medidas descriptivas de resumen. Resultados. Participaron 21 de 65 pacientes con diagnóstico de endometriosis de la pared abdominal. La media de edad al momento del diagnóstico fue de 35,3 años (desviación estándar, DE=8), el 71,4 % tenía el antecedente de cesárea y, el 38,1 %, el de endometriosis pélvica. El 95,2 % de las pacientes manifestaron dolor, de las cuales el 50 % lo percibió como constante con agudización cíclica y, el 40 %, como cíclico; además, el 90,5 % manifestó sensación de masa. La mediana del tiempo desde la aparición de la lesión hasta el diagnóstico, fue de 24 meses (RIQ=6-60). Solo en cuatro pacientes se hizo el diagnóstico prequirúrgico. El tratamiento fue quirúrgico en todas las pacientes y ocho (38,1 %) presentaron recidiva. Conclusiones. La endometriosis de la pared abdominal usualmente se manifiesta como masas dolorosas asociadas con cicatrices quirúrgicas previas, generalmente de origen ginecológico y los síntomas empeoran con la menstruación. Es usual que su diagnóstico sea tardío y pocas veces se hace antes del estudio histopatológico. El tratamiento de elección es la resección quirúrgica, aunque no es despreciable el porcentaje de recidivas.

Primary Cutaneous Umbilical Melanoma: The Michigan Experience

BACKGROUND

Primary cutaneous umbilical melanoma is rare. Thorough information regarding its characteristics and treatment, including use of sentinel lymph node biopsy (SLNB) staging, is difficult to obtain. The unique anatomy of the umbilicus adds to the complexity of diagnosing and treating melanoma at this site.

OBJECTIVE

To improve understanding of diagnosis and treatment of primary cutaneous umbilical melanoma through presenting 7 new cases and reviewing 39 cases in the literature.

MATERIALS AND METHODS

The University of Michigan melanoma database query and review of the literature regarding reported cases of primary umbilical melanoma.

RESULTS

In 7 new and 39 previously reported cases of primary cutaneous umbilical melanoma, we describe signs and symptoms, histopathologic features, differential diagnosis, relevant anatomical considerations, and definitive treatment including SLNB when applicable.

CONCLUSION

Our series, combined with a thorough literature review and compilation of findings, provides a better understanding and appreciation of melanoma in the unique anatomical site of the umbilicus, with a reminder to carefully examine the umbilicus during a full skin examination in patients at risk of melanoma. Primary umbilical melanoma presents and can be appropriately treated similarly to cutaneous melanoma in other sites, with attention to relevant anatomy.

Primary umbilical endometriosis

OBJECTIVE

to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis.

METHODS

an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence.

RESULTS

six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period.

CONCLUSION

umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

Cutaneous endometriosis: Presentation of 33 cases and literature review

OBJECTIVE

Cutaneous endometriosis is a rare condition that usually affects the abdominal wall in women with a history of open abdominal surgery. It has a characteristic clinical picture of a mass and pain associated with menstruation. The diagnosis is difficult on being an uncommon and little known condition. Once there is suspicion, a correct anamnesis and examination is usually sufficient. The treatment is normally surgery.

STUDY DESIGN

The study included all women identified with a diagnosis of cutaneous endometriosis over a period of 20 years. The variables collected and analysed included, age, surgical history, gynaecology history, symptoms, time period between surgery and consultation, specialist consulted, location, size, tests performed, treatment, and recurrence.

RESULTS

A total of 33 women were identified, with a mean age of 35.4 ± 2.33 years. A surgical history was found in 31 (93%) of 33 women. The main symptom was abdominal mass (96%), followed by period pain (51%), and non-period pain (42%). The initial diagnosis was correct in 15 (45%) of 33 women, and after performing further tests it was correct in 23 (69%) of 33 women. The main additional test was fine needle aspiration (FNA) in 24 (72%) of 33 patients. Surgery was performed on 30 (90%) of 33 women, with 8 (24%) women requiring a prosthesis. There was a recurrence of cutaneous endometriosis in 3 (9%) women.

CONCLUSION

Although it is a rare disease, its association with gynaecological surgery, and in particular caesarean section, means that there should be more awareness of this condition. Its diagnosis may be complicated due to lack of knowledge, when a proper examination and anamnesis can give us the key.

Primary Cutaneous Endometriosis of Umbilicus

Cutaneous endometriosis is defined by the presence of endometrial glands and/or stroma in skin and represents less than 1% of all ectopic endometrium. Cutaneous endometriosis is classified as primary and secondary. Primary cutaneous endometriosis appears without a prior surgical history and secondary cutaneous endometriosis mostly occurs at surgical scar tissue after abdominal operations. The most widely accepted pathogenesis of secondary endometriosis is the iatrogenic implantation of endometrial cells after surgery, such as laparoscopic procedures. However, the pathogenesis of primary endometriosis is still unknown. Umbilical endometriosis is composed only 0.4% to 4.0% of all endometriosis, however, umbilicus is the most common site of primary cutaneous endometriosis. A 38-year-old women presented with solitary 2.5×2.0-cm-sized purple to brown colored painful nodule on the umbilicus since 2 years ago. The patient had no history of surgical procedures. The skin lesion became swollen with spontaneous bleeding during menstruation. The skin lesion was diagnosed as a keloid at private hospital and has been treated with lesional injection of steroid for several times but there was no improvement. Imaging studies showed an enhancing umbilical mass without connection to internal organs. Biopsy specimen showed the several dilated glandular structures in dermis. They were surrounded by endometrial-type stroma and perivascular infiltration of lymphocytes. The patient was diagnosed as primary cutaneous endometriosis and skin lesion was removed by complete wide excision without recurrence. We report an interesting and rare case of primary umbilical endometriosis mistaken for a keloid and review the literatures.

Primary umbilical endometriosis successfully treated with dienogest

Primary umbilical endometriosis (PUE) is a rare gynaecological disorder. A majority of the reported cases were treated with surgical excision as medical treatment had been found to be less successful. We reported a case of PUE successfully treated with dienogest without any profound side effects from the drug.

Umbilical Nodule with Cyclical Bleeding: A Case Report and Literature Review of Atypical Endometriosis

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. It affects 3 to 10 percent of women of reproductive age. Umbilical endometriosis is rare, with an estimated incidence of 0.5–1.0% among all cases of endometriosis, and is usually secondary to prior laparoscopic surgery involving the umbilicus. In this report, we described a case of umbilical endometriosis treated with surgical resection and highlight the great importance of medical history compared to complementary diagnostic tests that can be sometimes inconclusive.

Primary Umbilical Endometriosis: Unusual and Rare Clinical Presentation

Primary umbilical endometriosis is a rare disorder and is defined as the presence of ectopic endometrial tissue within the umbilicus. A patient with painful mass in the umbilicus during menstrual period is studied in this paper. The possibility of subcutaneous endometriosis should be considered when an umbilical mass is detected despite the absence of previous surgery. In this case, urachal cancer, urachal remnant, umbilical endometriosis, and its malignant transformation were among the diseases considered in the differential diagnosis. Complete excision and histology are necessary to obtain a definitive diagnosis and optimal treatment for umbilical subcutaneous endometriosis.

Spontaneous cutaneous endometriosis of the umbilicus

Cutaneous endometriosis that arises de novo, without a prior history of surgery, is a rare phenomenon. The clinical diagnosis of cutaneous endometriosis remains challenging due to the variable clinical appearance and symptoms of the condition, and therefore must be considered in the differential diagnosis of any umbilical lesion. We report a 31-year-old woman who presented with spontaneous cutaneous endometriosis of the umbilicus.

Spontaneous cutaneous endometriosis in the mons pubis region: a case report diagnosed by fine-needle aspiration biopsy

Most cutaneous endometriosis develops at the site of an abdominal surgical scar. Spontaneous cutaneous endometriosis is extremely rare. We report a case of spontaneous cutaneous endometriosis in the mons pubis region. A 41-year-old woman presented with a mass in the right mons pubis, causing cyclic pain associated with menses. Fine-needle aspiration (FNA) biopsy was performed. The smears contained three cellular components: honeycombed sheets of glandular epithelial cells, fragments of ovoid-to-spindle shaped stromal cells, and background inflammatory cells, including hemosiderin-laden macrophages, histiocytes, and neutrophils. Biphasic clusters of glandular epithelial cells and stromal cells were identified. FNA cytology is a safe and useful adjunctive tool for diagnosing cutaneous endometriosis.