1
|
Chou CW, Lai PT, Huang CC, Hong JB, Tai YJ. Primary spontaneous inguinal endometriosis: Two cases with emphasis on the diagnostic approach. Taiwan J Obstet Gynecol 2023; 62:474-479. [PMID: 37188458 DOI: 10.1016/j.tjog.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE While endometriosis is common, inguinal endometriosis with hernia is rarely observed, making its preoperative diagnosis challenging. CASE REPORT We report two cases of inguinal endometriosis with different presentations and focus on tailored surgical treatment. The two patients in our series presented with painful swelling in the right groin area. Surgery and pathological examination confirmed the diagnosis of endometriosis in both cases. Herniorrhaphy and excision of the extraperitoneal round ligament were performed in one patient with concomitant inguinal endometriosis and indirect inguinal hernia. CONCLUSION We highlight the importance of the preoperative evaluation of concomitant pelvic endometriosis, round ligament involvement, and endometriosis within the inguinal hernia sac. Inguinal endometriosis with or without hernia should be considered even in reproductive-aged women without a previous medical and surgical history. Postoperative hormonal therapy, including dienogest, can be considered to prevent disease recurrence.
Collapse
Affiliation(s)
- Ching-Wen Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ta Lai
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Chun Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jin-Bon Hong
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
2
|
Dalkalitsis A, Salta S, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, Daniilidis A, Athanasiadis A, Navrozoglou I, Paschopoulos M, Vatopoulou A, Kosmas I. Inguinal endometriosis: A systematic review. Taiwan J Obstet Gynecol 2022; 61:24-33. [PMID: 35181041 DOI: 10.1016/j.tjog.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.
Collapse
Affiliation(s)
- Alexandros Dalkalitsis
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Styliani Salta
- University Hospitals of Leicester, Haemophilia Centre, Leicester Royal Infirmary, Leicester, UK
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Daniilidis
- Second Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iordanis Navrozoglou
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Anastasia Vatopoulou
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece.
| |
Collapse
|
3
|
Kido A, Himoto Y, Moribata Y, Kurata Y, Nakamoto Y. MRI in the Diagnosis of Endometriosis and Related Diseases. Korean J Radiol 2022; 23:426-445. [PMID: 35289148 PMCID: PMC8961012 DOI: 10.3348/kjr.2021.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis.
Collapse
Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Mu B, Zhang Z, Liu C, Zhang K, Li S, Leng J, Li M. Long term follow-up of inguinal endometriosis. BMC WOMENS HEALTH 2021; 21:90. [PMID: 33653321 PMCID: PMC7927249 DOI: 10.1186/s12905-021-01235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.
Collapse
Affiliation(s)
- BoRan Mu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ZhiQiang Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Chongdong Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Kunning Zhang
- Department of Pathology, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ShuHong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - JinHua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - MengHui Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China.
| |
Collapse
|
6
|
Hirata T, Koga K, Taniguchi F, Takazawa N, Honda R, Tanaka T, Kurihara M, Nakajima J, Yoshimura K, Kitade M, Narahara H, Kitawaki J, Harada T, Katabuchi H, Horie S, Osuga Y. National survey of bladder endometriosis cases in Japan. J Obstet Gynaecol Res 2021; 47:1451-1461. [PMID: 33398892 DOI: 10.1111/jog.14656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 01/08/2023]
Abstract
AIM We aimed to describe the clinical presentation, operative or medical management, and postoperative recurrence of bladder endometriosis (BE). METHODS We conducted a national survey to investigate BE cases from 2006 to 2016 in Japan. Histologically diagnosed cases were extracted and then investigated for the following factors: age at diagnosis, body mass index, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, and postoperative recurrence. RESULTS Eighty-nine patients with pathologically benign BE were identified. Eighty patients underwent surgery, whereas nine did not. Moreover, 34 and 44 patients underwent transurethral resection (TUR) and partial cystectomy (PC), respectively. Cumulative recurrence rates were significantly higher with TUR than with PC (p < 0.05). The recurrence rate tended to be higher after laparoscopic PC (n = 24) than after open PC (n = 20), but the difference was not statistically significant (p = 0.0879). Of the nine nonsurgical patients, eight received hormonal therapy and one did not. Efficacy rates of dienogest, GnRH agonist, and OC were 85.7%, 66.7%, and 66.7%, respectively. Of five patients with BE extending to the ureter or ureteral orifices, two underwent PC and ureteroneocystostomy and one underwent total nephroureterectomy due to renal function loss. CONCLUSION To our knowledge, this is the first study to compare the postoperative recurrence of BE after TUR and PC. We found that cumulative recurrence rate is significantly lower after PC than after TUR. BE extending to the ureter or ureteral orifices is a very challenging condition. Further studies are required for the optimal management of BE.
Collapse
Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan.,Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Naoko Takazawa
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Ritsuo Honda
- Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo, Tokyo, Japan
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Oita University, Oita, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University, Kyoto, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology Doai Kinen Hospital Sumida-ku Japan.,Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Kaori Koga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| |
Collapse
|