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Deng P, Weng C, Xu J, Nie H. Endometrioid adenocarcinoma arising from abdominal wall endometriosis: A case report and literature review. J Obstet Gynaecol Res 2024; 50:1420-1424. [PMID: 38880948 DOI: 10.1111/jog.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/30/2024] [Indexed: 06/18/2024]
Abstract
Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39-year-old woman who presented with a 13-year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA-125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies.
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Affiliation(s)
- Panxia Deng
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chongrong Weng
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jian Xu
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Huilong Nie
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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2
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Tran Phung Dung T, Tu Minh P, Nguyen Ngoc H. Desmoid Tumor of the Rectus Abdominis Muscle: A Case Report. Cureus 2024; 16:e61383. [PMID: 38953071 PMCID: PMC11214934 DOI: 10.7759/cureus.61383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Desmoid tumors, also referred to as aggressive fibromatosis, represent an uncommon form of fibroblastic proliferation. These neoplasms may arise within any musculoaponeurotic structure throughout the body. They are classified as benign due to several distinctive features: histologically, they exhibit regular mitotic activity and are devoid of metastatic potential. Computed tomography (CT) remains the definitive modality for precise diagnosis, and surgical excision is strongly advised. This account details the manifestation of a desmoid tumor located in the anterior abdominal wall of a 31-year-old female patient who notably lacks any prior surgical interventions. The surgical intervention entailed the excision of the neoplasm and subsequent reconstruction of the abdominal wall utilizing a polypropylene mesh. Postoperatively, the patient was released from the medical facility after a period of three days, having experienced no post-surgical complications. This was followed by a six-month interval free of any adverse events.
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Affiliation(s)
| | - Phuoc Tu Minh
- Digestive Surgery, Cho Ray Hospital, Ho Chi Minh City, VNM
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3
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Kalfoutzou A, Restemi A, Mylonakis A, Papadimitropoulos K, Matsaridis D, Peraki A, Tsantopoulos M, Chaleplidis N. Rectus Abdominis Endometriosis Following Cesarean Section: A Case Report. Cureus 2024; 16:e55462. [PMID: 38571836 PMCID: PMC10988277 DOI: 10.7759/cureus.55462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Endometriosis involves the growth of endometrial-like tissue outside the uterine cavity, with its manifestation in the rectus abdominis muscle being exceptionally rare and primarily observed in women with a history of abdominal surgeries. In this report, we present the case of a 42-year-old female with a medical history of two cesarean sections who presented with cyclical abdominal pain and a palpable mass in the right lower quadrant. An MRI scan of the pelvis revealed a lesion on the right lower quadrant of the abdominal wall, proximate to the previous Pfannenstiel incision. A percutaneous US-guided biopsy of the abdominal lesion was performed, and histopathology demonstrated the presence of endometrial glands and stroma, confirming the diagnosis of rectus abdominis endometriosis. She was submitted to a local wide excision with adequate margins of normal surrounding tissue and has remained free of recurrence for two years.
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Affiliation(s)
- Areti Kalfoutzou
- Department of Medical Oncology, 251 Air Force General Hospital, Athens, GRC
| | - Asimina Restemi
- Department of Pathology, 251 Air Force General Hospital, Athens, GRC
| | - Adam Mylonakis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | | | - Andria Peraki
- Department of Gynecology, Elena Venizelou General Maternal Hospital, Athens, GRC
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4
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Petit C, Donval L, Chandeze M, Chis C, Joste M, Panel P. Surgery of abdominal wall endometriosis associated with clear-cell carcinoma: Case report and review. J Gynecol Obstet Hum Reprod 2023; 52:102561. [PMID: 36841330 DOI: 10.1016/j.jogoh.2023.102561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Abdominal wall is a rare location for endometriosis, with a reported incidence of parietal endometriosis of approximately 0.03 to 0.4%. It most often occurs in the aftermath of a caesarean section and is associated with pelvic endometriosis in only 5 to 15% of cases. Rare cases of malignant transformation have been described, mainly in the form of clear-cell tumours. We report the case of a 52-year-old patient with a history of endometriosis who presented with a retractile parietal mass at the level of her caesarean scar. Histological analysis confirmed a clear-cell adenocarcinoma (CCC). Few cases of endometriosis - associated CCC are described in the literature. A review of the literature suggests radical surgical treatment combined with adjuvant radio-chemotherapy. However, the prognosis is poor. The aim of this case report is to suggest the diagnosis of malignant transformation in the presence of a rapidly evolving parietal mass in the context of endometriosis and a history of caesarean section.
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Affiliation(s)
- C Petit
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - L Donval
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France.
| | - M Chandeze
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - C Chis
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - M Joste
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - P Panel
- Service de Gynécologie-Obstétrique, Centre hospitalier de Versailles - Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
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5
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Ye H, Shen C, Quan Q, Xi M, Li L. Endometriosis of the skeletal muscular system (ESMS): a systematic review. BMC Womens Health 2023; 23:37. [PMID: 36703173 PMCID: PMC9878923 DOI: 10.1186/s12905-023-02184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Hui Ye
- grid.13291.380000 0001 0807 1581Gynecology Department of West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041 China
| | - Chongyang Shen
- grid.411304.30000 0001 0376 205XBasic Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137 China
| | - Qingli Quan
- grid.410737.60000 0000 8653 1072Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 China ,grid.8547.e0000 0001 0125 2443Fudan University, Shanghai, 201203 China
| | - Mingrong Xi
- grid.13291.380000 0001 0807 1581Gynecology Department of West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041 China
| | - Lin Li
- grid.13291.380000 0001 0807 1581Gynecology Department of West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041 China
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Muacevic A, Adler JR, Akbas G. A Rare Occurrence of Endometriosis Externa Individually Within the Rectus Abdominis Muscle. Cureus 2023; 15:e33662. [PMID: 36788899 PMCID: PMC9916474 DOI: 10.7759/cureus.33662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Endometriosis is defined as the presence of ectopic functional endometrial tissue outside the uterine cavity. It most commonly occurs in the pelvic organs, including the ovaries, ligaments of the uterus, and the pouch of Douglas. Extrapelvic implantation of endometrial tissue has also been reported in the literature. Extrapelvic endometriosis can be explained by lymphatic/vascular migration or mechanical transplantation of the tissue during surgery. Rectus abdominis muscle endometriosis is a rare phenomenon that usually presents with a palpable abdominal mass and cyclic pain. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) can be effective to define the location and size of the mass. Our patient was a 32-year-old woman presenting with cyclic abdominal pain and the development of an abdominal mass she had noticed for a year. USG and MRI scans revealed an endometrial focus in the right rectus abdominis muscle. Surgical excision with negative margins was performed, since surgical treatment of the lesion is offered as the definitive treatment.
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7
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Abdominal Wall Endometriosis. Obstet Gynecol Clin North Am 2022; 49:369-380. [DOI: 10.1016/j.ogc.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Giannella L, Serri M, Maccaroni E, DI Giuseppe J, Carpini GD, Berardi R, Sopracordevole F, Ciavattini A. Endometriosis-associated Clear Cell Carcinoma of the Abdominal Wall After Caesarean Section: A Case Report and Review of the Literature. In Vivo 2021; 34:2147-2152. [PMID: 32606196 DOI: 10.21873/invivo.12021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Clear cell carcinoma of the abdominal wall is a sporadic event. To date, about thirty cases have been reported in the literature. This article provides a case report and literature review of an infrequent occurrence with poor prognosis. CASE REPORT A 45-year-old woman with pelvic pain and an abdominal mass came to our attention. Her medical history was notable for two previous cesarean sections. Physical examination revealed a smooth, multilocular mass measuring about 20 cm, arising from the previous surgical scar. Histology revealed clear-cell carcinoma resulting from the transformation of abdominal wall endometriosis. Given the disease extent, the patient underwent front-line chemotherapy. After several and multiple chemotherapy regimens, there was a disease progression that resulted in the death of the patient in 7 months. The literature review showed that a previous cesarean section was present in 91% of cases. Besides, approximately 26.5% of women died within 12 months of being diagnosed. The mean age of women was 45.88 years, while the average size of the lesion was 11 cm. CONCLUSION Clear cell carcinoma is a rare but occurring event. Middle-aged women showing an abdominal wall mass in close relation with a surgical scar from a previous cesarean section must be promptly investigated. Treatment options usually include surgery and chemotherapy with poor results.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Serri
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Elena Maccaroni
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Jacopo DI Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, CRO Centro di Riferimento Oncologico National Cancer Institute, Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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9
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Melnyk AI, Foley CE, Lee TT. Endometriosis of the Rectus Muscle: A Single-Center Experience and a Novel Laparoscopic Approach. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexandra I. Melnyk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine (UPMC), Magee–Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Christine E. Foley
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine (UPMC), Magee–Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Ted T. Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine (UPMC), Magee–Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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10
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Guerriero S, Conway F, Pascual MA, Graupera B, Ajossa S, Neri M, Musa E, Pedrassani M, Alcazar JL. Ultrasonography and Atypical Sites of Endometriosis. Diagnostics (Basel) 2020; 10:diagnostics10060345. [PMID: 32471042 PMCID: PMC7345680 DOI: 10.3390/diagnostics10060345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present.
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Affiliation(s)
- Stefano Guerriero
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
- Correspondence:
| | - Francesca Conway
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Betlem Graupera
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Silvia Ajossa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Manuela Neri
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Eleonora Musa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Marcelo Pedrassani
- Hospital Maternidade Carmela Dutra and ClinusClínica de Imagem, Florianopolis 88015–270, Brazil;
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, 31008 Pamplona, Navara, Spain;
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11
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Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 27:373-389. [DOI: 10.1016/j.jmig.2019.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 02/08/2023]
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12
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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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13
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Rectus Abdominis Endometrioma after Caesarean Section. Case Rep Surg 2016; 2016:4312753. [PMID: 27999704 PMCID: PMC5141303 DOI: 10.1155/2016/4312753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
Abstract
Isolated rectus abdominis muscle endometriosis is very uncommon with less than 20 case reports being published to date since its first description in 1984 by Amato and Levitt. We report another case of isolated rectus abdominis endometriosis in a 37-year-old patient with a previous caesarian section. We also discuss the diagnostic and treatment particularities in these patients. In our case, the treatment was only surgical and currently the patient is disease-free during the 24-month follow-up.
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14
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García-Gavilán MDC, Fernández-Pérez F, Hinojosa-Guadix J, González-Bárcenas ML. [Rectus abdominal endometriosis on cesarean scar]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:341-3. [PMID: 26072138 DOI: 10.1016/j.gastrohep.2015.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/26/2015] [Accepted: 04/29/2015] [Indexed: 11/25/2022]
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15
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Increased dose single-agent gemcitabine in platinum-taxane resistant metastatic ovarian cancer. TUMORI JOURNAL 2015; 101:36-40. [PMID: 25702671 DOI: 10.5301/je.5000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
CONCLUSION In platinum–taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. PATIENTS AND METHODS Between 2004 and 2013, patients afflicted with platinum–taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m2 on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. RESULTS Twenty-six patients with platinum–taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum–taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum–taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum–taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. CONCLUSIONS Second- and third-line gemcitabine at a dose of 1,250 mg/m2 on days 1, 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum–taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.
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16
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Ozkan OF, Cikman O, Kiraz HA, Roach EC, Karacaer MA, Karaayvaz M. Endometrioma localized in the rectus abdominis muscle: a case report and review of literature. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:304-6. [PMID: 25626946 PMCID: PMC4743229 DOI: 10.1590/s0102-67202014000400019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 07/24/2014] [Indexed: 11/23/2022]
Affiliation(s)
- Omer F Ozkan
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | - Oztekin Cikman
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | - Hasan Ali Kiraz
- Department of Anestesiology, Medical School, Canakkale 18 Mart University, Canakkale, Turkey
| | - Emir C Roach
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | | | - Muammer Karaayvaz
- Department of General Surgery, Medical School, Canakkale 18 Mart University
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17
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Ozkan OF, Cikman O, Kiraz HA, Roach EC, Karacaer MA, Karaayvaz M. Endometrioma localized in the rectus abdominis muscle: a case report and review of literature. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27:230-1. [PMID: 25184781 PMCID: PMC4676371 DOI: 10.1590/s0102-67202014000300019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/13/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Omer F Ozkan
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | - Oztekin Cikman
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | - Hasan Ali Kiraz
- Department of Anestesiology, Medical School, Canakkale 18 Mart University, Canakkale, Turkey
| | - Emir C Roach
- Department of General Surgery, Medical School, Canakkale 18 Mart University
| | | | - Muammer Karaayvaz
- Department of General Surgery, Medical School, Canakkale 18 Mart University
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18
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Coccia ME, Rizzello F, Nannini S, Cozzolino M, Capezzuoli T, Castiglione F. Ultrasound-guided excision of rectus abdominis muscle endometriosis. J Obstet Gynaecol Res 2014; 41:149-52. [DOI: 10.1111/jog.12502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Francesca Rizzello
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Sara Nannini
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Mauro Cozzolino
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Tommaso Capezzuoli
- Department of Clinical and Experimental Biomedical Sciences; School of Medicine; University of Florence; Florence Italy
| | - Francesca Castiglione
- Department of Human Pathology and Oncology; School of Medicine; University of Florence; Florence Italy
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19
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Alvarez P, Levine JD. Screening the role of pronociceptive molecules in a rodent model of endometriosis pain. THE JOURNAL OF PAIN 2014; 15:726-33. [PMID: 24755283 PMCID: PMC4119016 DOI: 10.1016/j.jpain.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/01/2014] [Accepted: 04/08/2014] [Indexed: 01/09/2023]
Abstract
UNLABELLED Chronic pain is a major symptom in patients with endometriosis, a common gynecologic condition affecting women in their reproductive years. Although many proalgesic substances are produced by endometriosis lesions, experimental evidence supporting their relative roles is still lacking. Furthermore, it is unclear whether these proalgesic agents directly activate nociceptors to induce endometriosis pain. To determine their relative contribution to pain associated with endometriosis, we evaluated the intrathecal administration of oligodeoxynucleotides (ODNs) antisense to messenger RNA for receptors for 3 pronociceptive mediators known to be produced by the ectopic endometrium. Two weeks after the implant of autologous uterine tissue onto the gastrocnemius muscle, local mechanical hyperalgesia was observed in operated rats. Intrathecal antisense ODN targeting messenger RNA for the interleukin 6 receptor-signaling complex subunit glycoprotein 130 and the nerve growth factor tyrosine kinase receptor A, but not their mismatch ODNs, reversibly attenuated mechanical hyperalgesia at the implant site. In contrast, intrathecal antisense ODN targeting the tumor necrosis factor receptor 1, at a dose that markedly inhibited intramuscularly injected tumor necrosis factor alpha, had only a small antihyperalgesic effect in this model. These results indicate the relative contribution of pronociceptive mediators produced by ectopic endometrial tissue to endometriosis pain. The experimental approach presented here provides a novel method to evaluate for the differential contribution of mediators produced by other painful lesions as well as endometriosis lesions as targets for novel treatment of pain syndromes. PERSPECTIVE This article presents evidence for the relative contribution of proalgesic mediators to primary hyperalgesia displayed by rats submitted to a model of endometriosis pain. This approach can be used to identify potential targets for the treatment of endometriosis pain.
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Affiliation(s)
- Pedro Alvarez
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California; Division of Neuroscience, University of California San Francisco, San Francisco, California
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California; Division of Neuroscience, University of California San Francisco, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California.
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20
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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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21
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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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22
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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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23
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Alvarez P, Chen X, Hendrich J, Irwin JC, Green PG, Giudice LC, Levine JD. Ectopic uterine tissue as a chronic pain generator. Neuroscience 2012; 225:269-82. [PMID: 22922120 DOI: 10.1016/j.neuroscience.2012.08.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 11/16/2022]
Abstract
While chronic pain is a main symptom in endometriosis, the underlying mechanisms and effective therapy remain elusive. We developed an animal model enabling the exploration of ectopic endometrium as a source of endometriosis pain. Rats were surgically implanted with autologous uterus in the gastrocnemius muscle. Within two weeks, visual inspection revealed the presence of a reddish-brown fluid-filled cystic structure at the implant site. Histology demonstrated cystic glandular structures with stromal invasion of the muscle. Immunohistochemical studies of these lesions revealed the presence of markers for nociceptor nerve fibers and neuronal sprouting. Fourteen days after surgery rats exhibited persistent mechanical hyperalgesia at the site of the ectopic endometrial lesion. Intralesional, but not contralateral, injection of progesterone was dose-dependently antihyperalgesic. Systemic administration of leuprolide also produced antihyperalgesia. In vivo electrophysiological recordings from sensory neurons innervating the lesion revealed a significant increase in their response to sustained mechanical stimulation. These results are consistent with clinical and pathological findings observed in patients with endometriosis, compatible with the ectopic endometrium as a source of pain. This model of endometriosis allows mechanistic exploration at the lesion site facilitating our understanding of endometriosis pain.
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Affiliation(s)
- P Alvarez
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA
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Marci R, Lo Monte G, Soave I, Bianchi A, Patella A, Wenger JM. Rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis. J Obstet Gynaecol Res 2012; 39:462-5. [DOI: 10.1111/j.1447-0756.2012.01933.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Desmoid tumor of the anterior abdominal wall in female patients: comparison with endometriosis. Case Rep Med 2012; 2012:725498. [PMID: 22778752 PMCID: PMC3385014 DOI: 10.1155/2012/725498] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/30/2012] [Accepted: 05/08/2012] [Indexed: 12/16/2022] Open
Abstract
In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor.
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