Pyramidalis muscle endometriosis in absence of previous surgery

Endometriosis of the skeletal muscular system (ESMS): a systematic review

BACKGROUND

Extrapelvic endometriosis occurring at skeletal muscle and joint sites is not rare and is prone to delayed diagnosis and inappropriate treatment. Herein, endometriosis of the skeletal muscular system (ESMS) is systematically reviewed to facilitate early diagnosis and treatment.

METHODS

Literature on ESMS published before March 2022 was retrieved from the Ovid Medline and Web of Science databases, and the major clinical data were extracted for descriptive analysis.

RESULTS

A total of 62 studies (78 ESMS cases) met these requirements. The ESMS included the abdominal muscles (50.7%), pelvic floor muscles (11.6%), lower limb muscles (11.6%), hip muscles (8.7%), lumbar muscles (7.2%), joints (5.8%), upper limb muscles (2.9%), and shoulder-neck muscles (1.4%). The age was 34.0 ± 7.2 years (range 17-49 years). Approximately 63.8% of patients had at least one previous pelvic surgery, and 76.8% of local symptoms were related to the menstrual cycle. The course of disease was 29.6 ± 25.4 months (range 0.5-96 months). Only 30.3% of the patients sought initial medical advice from gynecologists, while 69.7% sought initial medical advice from a nongynecological physician. Twenty-seven patients underwent fine-needle aspiration (FNA) under ultrasound or CT monitoring, and only 44.4% (12/27) were confirmed to have endometriosis by FNA tissue pathology. Approximately 47.4% (37/78) of the patients had a normal pelvic cavity appearance. Surgical resection was performed in 92.3% (72/78) of the patients, of whom 88.9% (64/72) underwent complete resection of the lesion (negative surgical margin) and 20.8% (15/72) received postoperative hormone therapy. At 16.7 months of follow-up, 83.3%, 13.8%, 2.9%, and four patients had complete response, partial response, recurrence, and permanent function impairment, respectively.

CONCLUSION

Endometriosis can occur at almost any site in the musculoskeletal system. For women of reproductive age with catamenial pain or a mass in the musculoskeletal system, endometriosis should be suspected. Fine-needle aspiration can easily lead to missed diagnoses. Surgical resection for negative margins is the main treatment, and permanent impairment of function may occur in a few patients due to delayed diagnosis. Vascular lymphatic metastasis is the most likely mechanism of pathogenesis.

Thrombosis of iliac vessels, a rare complication of endometriosis: Case report and review of literature

A young women presented with iliac vein thrombosis, as extrapelvic endometriosis complication. Endometriosis mass had a subfascial position at the level of external oblique muscle and extended to the iliac vein. This paper reviewed the literature on endometriosis cases localized into striated muscles and cases of deep vein thrombosis due to this disease. There are not similar cases in the literature. The diagnostic role of ultrasound, in obtaining the definitive histological diagnosis, may be further enhanced through Elasticity Imaging Techniques and ultrasound-guided biopsy.

[Iatrogenic endometriosis during reproductive age: main issues?]

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.

Large-muscle endometriosis involving the adductor tight compartment: case report

Extrapelvic endometriosis is an uncommon condition but can involve nearly every organ, resulting in a wide range of clinical manifestations. Herein, we describe the case of a 45-year-old woman not a candidate for hormonal therapy who had cyclic pain in the left thigh associated with progressive impairment of walking ability. Clinical, instrumental, and laboratory data supported the diagnosis of endometriosis involving the adductor muscles compartment associated with ovarian endometriomas. Laparoscopic bilateral salpingo-oophorectomy and local wide excision in collaboration with an experienced orthopedic oncologist were performed, and definitive histologic analysis confirmed the diagnosis of endometriosis. The patient was pain-free at 6-month follow-up and demonstrated substantial improvement in ambulation and quality of life. Large-muscle endometriosis is a rare entity that can compromise musculoskeletal integrity and decrease quality of life. In this case, surgical excision in collaboration with an orthopedic oncologist was the cornerstone of treatment.

Endometriosis of the soleus and gastrocnemius muscles

OBJECTIVE

To document a rare case of endometriosis in the soleus and gastrocnemius muscles.

DESIGN

Case report.

SETTING

Tertiary care center.

PATIENT(S)

A 30-year-old fertile woman presented with moderate dysmenorrhea associated with calf pain and bulging that had been gradually worsening over the last years, particularly during menses. A mass in the soleus and gastrocnemius muscles was identified in ultrasonography and magnetic resonance imaging.

INTERVENTION(S)

Endometriosis was diagnosed by incisional biopsy on the basis of histopathology, and wide excisional biopsy was performed.

MAIN OUTCOME MEASURE(S)

Unusual clinical presentation of endometriosis.

RESULT(S)

The patient was disease free for 2 months. Recurrence of the lesion was then diagnosed, and a new surgical approach was planned.

CONCLUSION(S)

Endometriosis in muscles is a rare event, and existing theories are not totally sufficient in explaining it.

Endométriomes de la paroi abdominale : apport de l’imagerie

Endometrioma of the abdominal wall is a not well-recognized disease and usually develops after pelvic surgery. The most common presentation is a mass of the abdominal wall associated with pain during menstruation. We report six cases of parietal endometriomas studied with ultrasonography, CT, and in one case with MRI. Our results are compared with recent findings in the literature. The purpose of this study was to describe the clinical and imaging findings in abdominal wall endometriomas that can help reach a presurgical diagnosis.

[Malignant transformation of abdominal wall endometriosis: a new case report]

Cancer arising in abdominal wall endometriosis is a rare event, hindering diagnosis and making management uncertain. A cesarean section scar is generally at the origin of the disease. We report the case of a 45-year-old woman, with a past medical history of cesarean deliveries, complaining of a repeat abdominal wall endometriosis which transformed into a clear-cell carcinoma. Outcome was rapidly fatal. Compared with endometriosis-associated ovarian carcinoma, the prognosis of this abdominal scar complication is poor. In the literature, survival rate reaches only 57% after a short follow-up of 20 months. Clear-cell carcinoma is the most common histological subtype, followed by endometrioid carcinoma. Radical surgery is the main treatment. Good technique and proper care during cesarean section may help in preventing this endometriosis complication.