1
|
Alaert J, Lancelle M, Timmermans M, Tanos P, Nisolle M, Karampelas S. Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review. J Clin Med 2024; 13:2282. [PMID: 38673556 PMCID: PMC11050881 DOI: 10.3390/jcm13082282] [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: 03/18/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.
Collapse
Affiliation(s)
- Julie Alaert
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Mathilde Lancelle
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Tivoli, Université Libre de Bruxelles, 7100 La Louviere, Belgium;
| | - Marie Timmermans
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Panayiotis Tanos
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Stavros Karampelas
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| |
Collapse
|
2
|
Erdoğan P, Erdoğan A, Bolat H, Özbey C. Case controlled study for determination of risk factors in abdominal wall endometriosis following a cesarean section. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221093818] [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
Introduction: Abdominal wall endometriosis (AWE) is the presence of ectopic endometrial tissue in abdominal wall and is most frequently encountered in women with previous cesarean section (CS). The aim of this study is to evaluate the possible risk factors of AWE development. Methods: Women with previous CS and pathologically confirmed AWE were included into the study ( n = 33). Controls ( n = 127) were randomly selected among women who had previous CS and absence of AWE were confirmed by physical examination. Clinical characteristics of the patient and the CS operation preceding AWE were recorded. Results: CS was performed before onset of labor in 87.9% in AWE and in 59.1% of control group ( p = 0.002). The antenatal BMI and weight gain during pregnancy were significantly higher in AWE patients ( p < 0.0001; p = 0.002, respectively). In logistic regression model procedure duration ( p = 0.039; OR = 1083), antenatal BMI ( p = 0.003; OR = 1254), weight gain ( p = 0.002; OR = 1171), and CS before spontaneous labor ( p = 0.021; OR = 5169) were significant parameters for predicting AWE. Discussion: High antenatal BMI, weight gain during pregnancy, and longer duration of operation are all factors effecting subsequent AWE development. However, CS before spontaneous labor is by far the most powerful risk factor for AWE development.
Collapse
Affiliation(s)
- Pınar Erdoğan
- Obstetrics and Gynecology, Midwifery Department, Zübeyde Hanım School of Health, Niğde Ömer Halisdemir University, Merkez/Niğde, Turkey
| | - Alirıza Erdoğan
- Medical Faculty, General Surgery Department, Niğde Ömer Halisdemir University, Niğde Ömer Halisdemir University Research and Training Hospital, Merkez/Niğde, Turkey
| | - Hacı Bolat
- Medical Faculty, General Surgery Department, Niğde Ömer Halisdemir University, Niğde Ömer Halisdemir University Research and Training Hospital, Merkez/Niğde, Turkey
| | - Caner Özbey
- Medical Faculty, Pathology Department, Niğde Ömer Halisdemir University, Niğde Ömer Halisdemir University Research and Training Hospital, Merkez/Niğde, Turkey
| |
Collapse
|
3
|
Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review. Diagnostics (Basel) 2021; 11:diagnostics11040609. [PMID: 33805519 PMCID: PMC8065386 DOI: 10.3390/diagnostics11040609] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a debilitating disease characterized by endometrial glands and stroma outside the endometrial cavity. Abdominal wall endometriosis (AWE) indicates the presence of ectopic endometrium between the peritoneum and the skin, including subcutaneous adipose tissue and muscle layers, often following obstetric and gynecological surgical procedures. AWE is a not infrequent gynecological surgical complication, due to the increasing number of cesarean sections worldwide. In this pictorial review, we discuss the importance of medical history and physical examination, including the main ultrasound features in the diagnosis of AWE.
Collapse
|
4
|
Hasan A, Deyab A, Monazea K, Salem A, Futooh Z, Mostafa MA, Youssef A, Nasr M, Omar N, Rabaan AA, Taie DM. Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section. Ann Med Surg (Lond) 2021; 62:219-224. [PMID: 33537134 PMCID: PMC7843362 DOI: 10.1016/j.amsu.2021.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the past few decades, the rate of Cesarean Section (CS) delivery has been rising rapidly and the prevalence of CS-associated complications including Abdominal Wall Endometriomas (AWE) increases with each additional operation. The aim of this study was to evaluate the clinical characteristics, histopathological diagnostic role and surgical management of post-CS AWE through a retrospective case review. METHODS We calculated the incidence of AWE and reviewed all the patients underwent surgical removal of Post-CS AWE during the period of 2012-2018 who were diagnosed, treated and followed up for 2-8 years at our tertiary hospital. RESULTS Thirty women with AWE were included. The main symptom in 2/3 of cases was cyclic pain and 4 cases (13.3%) had no symptoms. The mean interval between prior CS and appearance of symptoms was 55.2 months and the mean size of the excised mass was 42 mm. Free surgical margin was less than 9 mm in 9 patients (30%) but no recurrence was recorded among all the studied patients. Pre-operative FNAC diagnosis was performed for only 3 patients (10%) which helped in excluding other potential pathologies. The clinical-pathological agreement value for detection of the nature of the abdominal wall mass was 93.4%. CONCLUSIONS Patients with suspected AWE should undergo preoperative cytological biopsy to exclude alternative diagnosis. Wide surgical excision with margin of less than 1 cm could be accepted especially in case of weak abdominal wall. More studies on the post-CS complications; risks, prevention, early detection and proper management should be encouraged.
Collapse
Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdou Deyab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Monazea
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Egypt
| | - Abdoh Salem
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zahraa Futooh
- Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mahmoud A. Mostafa
- Department of Internal Medicine and Cardiology, King Fahad Hospital, Albaha, Saudi Arabia
| | - Ahmed Youssef
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Nasr
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nasser Omar
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali A. Rabaan
- Molecular Diagnostic Labortaory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Doha M. Taie
- Department of Pathology, National Liver Institute, Menoufia University, Shebin El Kom, Egypt
| |
Collapse
|
5
|
Draghi F, Cocco G, Richelmi FM, Schiavone C. Abdominal wall sonography: a pictorial review. J Ultrasound 2020; 23:265-278. [PMID: 32125676 DOI: 10.1007/s40477-020-00435-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.
Collapse
Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Filippo Maria Richelmi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| |
Collapse
|
6
|
Cocco G, Ricci V, Boccatonda A, Schiavone C. Focused ultrasound for the diagnosis of non-palpable endometriotic lesions of the abdominal wall: a not-uncommon surgical complication. J Ultrasound 2020; 23:183-187. [PMID: 31919810 DOI: 10.1007/s40477-019-00425-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022] Open
Abstract
Endometriosis is a benign disease characterized by endometrial glands and stroma outside the endometrial cavity. We reported two cases of endometriosis of the abdominal wall, with subcutaneous and intramuscular localization, that became symptomatic a few years after a cesarean intervention. These cases have a clinical pattern quite similar to cutaneous endometriosis, but they are more difficult to diagnose through physical examination because they are barely palpable. In this sense, coupled with suggestive symptoms, ultrasound examination can confirm the clinical suspicion of endometriosis without the use of computed tomography and/or magnetic resonance imaging.
Collapse
Affiliation(s)
- Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy.
| | - V Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| |
Collapse
|
7
|
Marras S, Pluchino N, Petignat P, Wenger JM, Ris F, Buchs NC, Dubuisson J. Abdominal wall endometriosis: An 11-year retrospective observational cohort study. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100096. [PMID: 31650130 PMCID: PMC6804734 DOI: 10.1016/j.eurox.2019.100096] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/29/2019] [Accepted: 09/08/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of this study was to review the records of patients with excised abdominal wall endometriosis (AWE) to determine patient characteristics, diagnostic methods, presence of concurrent pelvic endometriosis and type of surgery. Study design Medical records from an 11-year period were searched to identify histologically confirmed AWE cases. Descriptive data were collected and analyzed. Two subgroups were differentiated: isolated AWE and pelvic endometriosis-associated AWE. Results Thirty-five women with AWE were included. The most common symptom was cyclic abdominal or parietal pain (68.6%); 17.1% of the women had no symptoms. Twenty-nine women (82.8%) had a history of gynecological or obstetrical surgery, most commonly cesarean section (CS). The mean interval between prior surgery and appearance of symptoms was 5.3 years. Six women (17.1%) had no prior surgery; all six presented with umbilical nodules, nulliparity and confirmed mild to severe pelvic endometriosis. Among all patients, 34.3% had concurrent pelvic endometriosis, 40% presented with isolated AWE and 25.7% had no pelvic exploration. Women with concurrent pelvic endometriosis had significantly lower parity, smaller nodule size and a higher likelihood of umbilical location than those with isolated AWE (p < 0.05). A history of CS was more commonly found in women with isolated AWE. The overall recurrence rate over the study period was 11.4%, with a mean follow-up period of 5.2 years. Conclusions AWE is an uncommon condition associated with long diagnostic and therapeutic delays. In patients with umbilical AWE and no surgical history, pelvic endometriosis is commonly present and should be highly suspected.
Collapse
Affiliation(s)
- Sandra Marras
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Nicola Pluchino
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Patrick Petignat
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Jean-Marie Wenger
- Faculty of Medicine, University of Geneva, 1 Rue Michel Servet, Geneva 1205, Switzerland
| | - Frédéric Ris
- Department of Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland
| | - Nicolas C Buchs
- Department of Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland
| | - Jean Dubuisson
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| |
Collapse
|
8
|
Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, Xu H. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC WOMENS HEALTH 2019; 19:14. [PMID: 30658623 PMCID: PMC6339338 DOI: 10.1186/s12905-019-0711-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Abstract
Background Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). The aim of this study was to systematically identify the clinical features of CSE and recommend precautionary measures. Methods A large, retrospective study was undertaken with CSE patients treated surgically at our hospital between January 2005 and December 2017. Results A total of 198 CSE patients were enrolled, with a mean age of 32.0 ± 4.0 years. The main complaint of the patients was abdominal mass (98.5%), followed by cyclic pain (86.9%). The latency period of CSE was 31.6 ± 23.9 months, and the duration between the onset of symptoms and this surgery was 28.3 ± 25.0 months. A majority (80.8%, n = 160) of the patients had undergone a Pfannenstiel incision, and a minority (19.2%, n = 38) a vertical midline incision. The latency period of CSE in the case of a Pfannenstiel incision was significantly shorter than that in the case of a vertical midline incision (24.0 vs 33.0 months, P = 0.006). A total of 187 (94.4%) patients had a single endometrioma, 11 (5.6%) patients had multiple endometriomas, and the 11 multiple-endometrioma patients had all undergone a Pfannenstiel incision. Lesions of endometrioma were common in corner sites, after either incision: 142/171 (83.0%) in Pfannenstiel incision scars and 32/38 (84.2%) in vertical incision scars. Conclusions The findings of this study indicate that the Pfannenstiel incision carries a higher risk of CSE than the vertical midline incision. Thorough cleaning at the conclusion of CS, particularly of both corner sites of the adipose layer and the fascia layer, is strongly recommended for CSE prevention. Further studies might provide additional recommendations.
Collapse
Affiliation(s)
- Ping Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yabing Sun
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chen Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yeping Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Linna Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
| | - Hong Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
| |
Collapse
|
9
|
Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review. Case Rep Obstet Gynecol 2017; 2017:8062924. [PMID: 28326210 PMCID: PMC5343249 DOI: 10.1155/2017/8062924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/08/2017] [Indexed: 11/17/2022] Open
Abstract
Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. Scar endometriosis has been described following obstetrical and gynecological surgery. It is a rare condition, though probably on the rise, due to the considerable increase of cesarean sections performed worldwide. Its physiopathology is complex; its symptomatology is rich and diverse but thorough clinical examination along with ultrasound imaging and potentially pretherapeutic cytologic evaluation are usually efficient in diagnosing the condition. Treatment is mostly surgical. We report the case of a cesarean section scar endometriosis, managed at a tertiary level center and emphasize the diagnosis and treatment options.
Collapse
|
10
|
Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J Minim Invasive Gynecol 2017; 24:478-484. [PMID: 28104496 DOI: 10.1016/j.jmig.2017.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/03/2017] [Accepted: 01/07/2017] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the risk factors, presentation, and outcomes in cases of abdominal wall endometriosis. DESIGN A case-control study (Canadian Task Force classification II-2). SETTING An academic medical center. PATIENTS A total of 102 (34 cases and 68 controls) were included. INTERVENTIONS Surgical resection of abdominal wall endometriosis. MEASUREMENTS AND MAIN RESULTS Cases underwent surgical excision for abdominal wall endometriosis at Mayo Clinic from January 1, 2000, through December 31, 2013. For each case, 2 controls were randomly selected from a list of women who had surgery in the same year with minimal (American Society for Reproductive Medicine stage I-II) endometriosis. A chart review was completed for variables of interest. Regression models were used to identify independent risk factors associated with abdominal wall endometriosis. RESULTS In 14 years, 2539 women had surgery for endometriosis at Mayo Clinic. Of these, only 34 (1.34%) had abdominal wall endometriosis. The mean age was 35.2 ± 5.9 years, and the median parity was 2 (range, 0-5). Clinical examination diagnosed abdominal wall endometriosis in 41% of cases, with the cesarean delivery scar being the most common site (59%). There was a strong correlation between the size of the lesion on clinical examination compared with the size of the pathology specimen (r2 = 0.74, p < .001). When compared with controls, cases had significantly higher parity and body mass index, more cyclic localized abdominal pain, less dysmenorrhea, longer duration from the start of symptoms to surgery, and more gynecologic surgeries for symptoms without cure. In the final multivariable model, cyclic localized abdominal pain, absence of dysmenorrhea, and previous laparotomy were independently associated with abdominal wall endometriosis with adjusted odds ratios of 10.6 (95% CI 1.85-104.4, p < .001), 12.4 (95% CI 1.64-147.1, p < .001), and 70.1 (95% CI 14.8-597.7, p < .001), respectively, with an area under the curve for the receiver operating characteristic of 0.94 (95% CI, 0.87-0.98). After excision of the disease, repeat surgery was needed in 2 (5.9%) patients with a median time to recurrence of 50.5 (range, 36-65) months. CONCLUSIONS Abdominal wall endometriosis is a rare but unique form of endometriosis. Careful history and clinical examination can provide accurate diagnosis and avoid unnecessary delay before surgical intervention. Localized cyclic abdominal pain with the absence of dysmenorrhea and a history of prior laparotomy are independent risk factors with very high accuracy for diagnosis.
Collapse
Affiliation(s)
- Zaraq Khan
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
| | - Valentina Zanfagnin
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sherif A El-Nashar
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Abimbola O Famuyide
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Gaurang S Daftary
- Laboratory of Translation Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Matthew R Hopkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
11
|
Marcellin L, Morin C, Santulli P, Marzouk P, Bourret A, Dousset B, Borghese B, Chapron C. History of Uterine Surgery Is Not Associated With an Increased Severity of Bladder Deep Endometriosis. J Minim Invasive Gynecol 2016; 23:1130-1137. [DOI: 10.1016/j.jmig.2016.08.817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 12/26/2022]
|
12
|
Vellido-Cotelo R, Muñoz-González JL, Oliver-Pérez MR, de la Hera-Lázaro C, Almansa-González C, Pérez-Sagaseta C, Jiménez-López JS. Endometriosis node in gynaecologic scars: a study of 17 patients and the diagnostic considerations in clinical experience in tertiary care center. BMC WOMENS HEALTH 2015; 15:13. [PMID: 25783643 PMCID: PMC4337097 DOI: 10.1186/s12905-015-0170-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 01/27/2015] [Indexed: 12/19/2022]
Abstract
Background Endometriosis nodes are observed in extra pelvic locations, particularly in gynaecological scars, with the abdominal wall being one of the most frequent locations. The main objective of the study is to review patient characteristics of cases of endometriosis nodes in gynaecological scars. Methods A retrospective, observational and descriptive study with a cohort of patients from Hospital 12 de Octubre was conducted from January 2000 to January 2012. We analysed all of the patients who presented with an endometriosis node in a gynaecological scar presentation who had undergone surgery in that period. Descriptive data were collected and analysed. Results A total of 17 patients with an anatomopathological diagnosis of an endometriosis node in a gynaecological scar were found. The following variables were studied: the age at diagnosis (32.5 years +/− 5.5 years), personal and obstetric history, time from surgery to diagnosis (4.2 years +/− 3.4 years), symptoms (a painful mass that grows during menstruation is the most frequent symptom in our patients), technical analyses by computed tomography (CT), magnetic resonance (MR) or fine needle aspiration (FNA) (77% of the patients), node size (2.5 cm +/− 1.1 cm) and location (caesarean scar, 82%; episiotomy scar, 11.7%; and laparoscopic surgery port, 5.8%), involvement of adjacent structures (29% of the patients), treatment (exeresis with a security margin in all the patients) and other endometriosis locations (14% of the patients). Conclusions A high level of suspicion is required to diagnose gynaecological scar endometriosis, which should be suspected in the differential diagnosis of scar masses in reproductive-aged women. Several theories have been proposed to explain the formation of endometriosis nodes in extrauterine localizations. The two of them that seem to be more plausible are the metaplasia and transport theories. Imaging with ultrasound, CT and MR facilitate the diagnosis. FNA could be used for preoperative diagnosis. Treatment must be by node resection with a security margin. In some cases, surgery could be combined with hormonal treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0170-9) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Uçar MG, Şanlıkan F, Göçmen A. Surgical Treatment of Scar Endometriosis Following Cesarean Section, a Series of 12 Cases. Indian J Surg 2013; 77:682-6. [PMID: 26730088 DOI: 10.1007/s12262-013-0978-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022] Open
Abstract
It is difficult to conduct studies with larger series in rarely observed diseases. We report our experience in managing cesarean scar endometriosis (CSE) and emphasize the diagnosis and treatment options. The objective of our study is to review the clinical characteristics of CSE and to evaluate our surgical outcomes. We have collected and documented a case series of 12 patients who underwent surgical wide en bloc excision with surrounding clear margins for CSE. Patients' demographic features, symptoms, and clinical and operative findings were evaluated. The mean age was 34.6 years. Cyclical pain was documented in seven patients, while three patients presented with noncyclical pain. Menstrually-related enlargement of the nodule was observed in four patients, and only one patient had a complaint of dark brown leakage. The mean operation time was 26 min. The endometriotic lesions ranged from a diameter of 2 to 8 cm in size. Patients recovered completely, and no recurrence was observed. To prevent iatrogenic transplantation, additional attention is needed during surgery that exposes endometrial tissue. Complete wide excision of CSE is both diagnostic and therapeutic. To avoid unnecessary referrals, awareness of its typical clinical manifestations remains the mainstay for intervention. The most important issues to be considered during surgery is nonspreading endometriosis while manipulation.
Collapse
Affiliation(s)
- Mustafa Gazi Uçar
- Departments of Obstetrics and Gynecology, Konya Education and Research Hospital, Konya Eğitim ve Araştırma Hastanesi. Necip Fazil Mah. Atesbazi Sok. Meram Yeniyol, 42040 Meram Konya, Turkey
| | - Fatih Şanlıkan
- Departments of Obstetrics and Gynecology, Ümraniye Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Göçmen
- Departments of Obstetrics and Gynecology, Ümraniye Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Meng Xie
- Department of Ultrasound, Obstetrics and Gynecology Hospital, Fudan University, 128 Shen Yang Rd, 200090 Shanghai, China
| | | | | | | | | |
Collapse
|
15
|
A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet 2013; 121:41-4. [DOI: 10.1016/j.ijgo.2012.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/07/2012] [Accepted: 12/18/2012] [Indexed: 12/19/2022]
|
16
|
Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, Katz DS. Endometriosis of Abdominal and Pelvic Wall Scars: Multimodality Imaging Findings, Pathologic Correlation, and Radiologic Mimics. Radiographics 2012; 32:2031-43. [DOI: 10.1148/rg.327125024] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Francica G. Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar. World J Radiol 2012; 4:135-40. [PMID: 22590667 PMCID: PMC3351681 DOI: 10.4329/wjr.v4.i4.135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/23/2012] [Accepted: 03/30/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features.
METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases.
RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04).
CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.
Collapse
|
18
|
Nominato NS, Prates LFVS, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol 2010; 152:83-5. [PMID: 20510495 DOI: 10.1016/j.ejogrb.2010.05.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 04/27/2010] [Accepted: 05/03/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the incidence of scar endometriosis after different surgical procedures. STUDY DESIGN A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. RESULTS Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. CONCLUSION Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.
Collapse
Affiliation(s)
- Nilo Sérgio Nominato
- Postgraduate Medical School of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | |
Collapse
|
19
|
Francica G, Scarano F. Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars. J Ultrasound 2009; 12:101-6. [PMID: 23396117 DOI: 10.1016/j.jus.2009.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of the present study was to highlight the sonographic and clinical characteristics of large (≥30 mm in diameter) scar endometriomas near Pfannenstiel incisions, assuming that large size is a marker of delayed diagnosis. METHODS We compared clinical, ultrasound (US) and color Doppler findings in 13 patients (mean age 31.3 years) with 13 large scar endometriomas (L-SEs) (mean lesion diameter 41.8 mm; range 30-60 mm) and 17 women (mean age 30.7 years) with 19 small scar endometriomas (S-SEs) (mean lesion size 18.3 mm; range 7-26 mm). RESULTS Compared with the S-SE group, the L-SE group had a significantly longer mean interval between the last cesarean section and hospital admission (5.5 vs. 3.3 years; p < 0.01) and longer mean duration of symptoms before admission (43 vs. 17.4 months; p < 0.01). The L-SE group also had a significantly higher percentage of patients who had undergone at least one inconclusive diagnostic examination (Computed Tomography, Magnetic Resonance Imaging, fine needle biopsy, or laparoscopy) (39% vs. 0%; p < 0.05). As for US findings, L-SEs more frequently displayed cystic regions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05). CONCLUSIONS Delayed diagnosis of scar endometrioma reflected by a longer and more complex medical history results in larger than usual endometriomas with peculiar US findings, which are even more likely to be misinterpreted by physicians and radiologists.
Collapse
Affiliation(s)
- G Francica
- Diagnostic and Interventional Sonography Unit, Santa Maria della Pietà Hospital, Casoria (NA), Italy
| | | |
Collapse
|
20
|
Leite GKC, Carvalho LFPD, Korkes H, Guazzelli TF, Kenj G, Viana ADT. Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature. SAO PAULO MED J 2009; 127:270-7. [PMID: 20169275 DOI: 10.1590/s1516-31802009000500005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 10/28/2009] [Indexed: 12/23/2022] Open
Abstract
CONTEXT AND OBJECTIVE The incidence of scar endometrioma ranges from 0.03 to 3.5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. DESIGN AND SETTING Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. METHODS Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. RESULTS There were 33 patients, of mean age 30.1 +/- 5.0 years (range: 18-41 years). The total incidence was 0.11%: 0.29% in cesarean sections and 0.01% in vaginal deliveries. Twenty-nine tumors (87.9%) were located in cesarean scars, two (6.0%) in episiotomy scars and two (6.0%) in the umbilical region. The main symptom was localized cyclical pain (66.7%), of mean duration 30.5 months (+/- 23). Surgical treatment was successful in all cases. CONCLUSION This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.
Collapse
|
21
|
Francica G, Scarano F, Scotti L, Angelone G, Giardiello C. Endometriomas in the region of a scar from Cesarean section: sonographic appearance and clinical presentation vary with the size of the lesion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:215-220. [PMID: 19253349 DOI: 10.1002/jcu.20569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To describe the sonographic (US) appearances of endometriomas developed in the vicinity of a scar from Cesarean section and compare sonographic and clinical characteristics of large (> or =3 cm) scar endometriomas (LSEs) with small scar endometriomas (SSEs). METHOD Twenty-eight consecutive women (mean age, 31 years; range, 20-42) with 31 scar endometriomas (mean diameter, 2.7 cm; range, 0.7-6 cm) were examined by US, including color Doppler imaging prior to surgery. Clinical and US findings in women with LSE were compared with those of women with SSE. RESULTS Twelve patients had 12 LSEs with a mean longest diameter of 4.1 cm (range, 3-6 cm); in 1 case, a large nodule was associated with a small lesion. Sixteen women had 18 SSEs with a mean lesion size of 1.8 cm (range, 0.7-2.6 cm).The mean time interval between the last Cesarean section and hospital admission was longer in patients with LSE (66 versus 40 months; p < 0.01) as was the mean duration of symptoms before admission (43 versus 17 months; p < 0.01); in addition, 41.6% of patients with LSE had undergone previous inconclusive diagnostic examinations (CT, MRI, fine needle aspiration, or laparoscopy) compared with 0% in patients with SSE (p < 0.05). LSEs more frequently showed cystic portions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05) than SSEs did. CONCLUSION LSEs were associated with a delay in diagnosis and some US findings that could result in further diagnostic difficulties.
Collapse
Affiliation(s)
- Giampiero Francica
- Unità Operativa di Ecografia Diagnostica e Interventistica, Presidio Ospedaliero Camilliani S Maria della Pietà, Casoria (NA), Italy
| | | | | | | | | |
Collapse
|
22
|
Skret-Magierlo J, Wicherek L, Basta P, Galazka K, Sikora J, Wilk M, Fudali L, Skret A. RCAS1 Decidual Immunoreactivity during Cesarean Section in Scar Deciduosis: Immune Cell Presence and Activity. Gynecol Obstet Invest 2007; 65:187-94. [DOI: 10.1159/000111533] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 06/18/2007] [Indexed: 11/19/2022]
|