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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: 0] [Impact Index Per Article: 0] [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.
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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.
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Inguinal endometriosis with a disappearing mass preoperatively: A case report. Int J Surg Case Rep 2022; 91:106781. [PMID: 35093707 PMCID: PMC8802119 DOI: 10.1016/j.ijscr.2022.106781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Endometriosis is a common gynecological disease that affects approximately 10% of reproductive-age women. Inguinal endometriosis is uncommon, affecting only 0.6% of all patients with endometriosis. We present a case of inguinal endometriosis with a disappearing mass preoperatively. Presentation of case A 44-year-old woman presented with a palpable mass and pain in her left inguinal region. Computed tomography showed a 20-mm mass near the pubic tubercle. After 2 months of observation, the mass became impalpable and could not be confirmed by computed tomography; however, the inguinal pain did not improve regardless of menstrual cycles. Resection of the inguinal mass and the entire extraperitoneal portion of the uterine round ligament was performed. Histopathological examination revealed endometrial glands and stroma with CD10-positive cells, which confirmed inguinal endometriosis diagnosis. Erythrophagocytic macrophages indicated endometriosis-related hematoma absorption. Her symptoms disappeared after surgery, and no postoperative complications occurred. Discussion For treating inguinal endometriosis, the complete removal of the mass and the entire extraperitoneal portion of the round ligament by an anterior approach is necessary to prevent postoperative residual symptoms and recurrence. However, the preoperative diagnosis of inguinal endometriosis remains a challenge and is frequently discovered incidentally by intraoperative findings and pathological examination. Conclusion Clinicians should have a high suspicion of inguinal endometriosis and improved diagnostic precision to select the appropriate surgical approach. Regardless of menstrual variability, the feature of a decreased mass size caused by endometriosis-related hematoma absorption can serve as a preoperative diagnostic clue. Endometriosis affects approximately 10% of reproductive-age women. Inguinal endometriosis is uncommon and difficult to diagnose. Surgery is the first choice for symptom relief of inguinal endometriosis. Diagnostic precision improvement for inguinal endometriosis before surgery is crucial. The feature of decreased mass size can serve as a preoperative diagnostic clue.
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Camboni A, Marbaix E. Ectopic Endometrium: The Pathologist's Perspective. Int J Mol Sci 2021; 22:ijms222010974. [PMID: 34681634 PMCID: PMC8540175 DOI: 10.3390/ijms222010974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Endometriosis and adenomyosis are two frequent diseases closely linked, characterized by ectopic endometrium. Despite their benign nature, endometriosis and adenomyosis impair women’s quality of life by causing pain and infertility and an increase in the incidence of gynecological malignancies has been reported. Since the first description of ectopic endometrium in 1860, different attempts have been made to describe, classify and understand the origin of these diseases. Several theories have been proposed to describe the pathogenic mechanism leading to the development of adenomyosis or endometriosis. However, all the hypotheses show some limitations in explaining all the different aspects and manifestations of these diseases. Despite the remarkable progress made over recent years, the pathogeneses of endometriosis and adenomyosis remain unclear. Moreover, because of the lack of standardized protocols and diagnostic criteria in pathology practice it is difficult to study and to classify these disorders. The goal of this review is to summarize the pathological aspects of adenomyosis and endometriosis, spanning a historical perspective to newly reported data.
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Affiliation(s)
- Alessandra Camboni
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 1200 Brussels, Belgium
- Pathology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
- Correspondence:
| | - Etienne Marbaix
- Pathology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
- Cell Biology Unit, de Duve Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
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Hakoda K, Yoshimitsu M, Miguchi M, Kohashi T, Egi H, Ohdan H, Hirabayashi N. Characteristic findings of appendicular endometriosis treated with single incision laparoscopic ileocolectomy: Case report. Int J Surg Case Rep 2020; 67:9-12. [PMID: 31991379 PMCID: PMC7076268 DOI: 10.1016/j.ijscr.2019.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION We report the case of characteristic findings of appendicular endometriosis that presented as a submucosal tumor in the cecum without any abdominal symptoms treated with single-incision laparoscopic ileocolectomy. PRESENTATION OF CASE The patient was a 51-year-old woman (body mass index: 21.5) who underwent an examination to investigate the cause of a positive fecal occult blood test. Her laboratory test results were normal, without anemia or tumor marker elevation. Colonoscopy revealed a submucosal tumor in the cecum. Enhanced computed tomography (CT), fluorodeoxyglucose-positron emission tomography-CT and magnetic resonance imaging failed to produce a clear diagnosis. Given the malignant potentiality of the tumor, ileocolectomy was considered potentially necessary, but she wished for minimally invasive surgery. She ultimately underwent ileocolectomy and lymphadenectomy with single-incision laparoscopic surgery. A pathological examination revealed the lesion to be appendicular endometriosis, and 14 lymph nodes with no malignancy were resected. CONCLUSION Appendicular endometriosis can present as a submucosal tumor in the cecum without any abdominal symptoms. Appendicular endometriosis should be considered in the differential diagnosis of ileocecal submucosal tumor. Single-incision laparoscopic ileocolectomy was useful procedure for cecum tumor resection.
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Affiliation(s)
- Keishi Hakoda
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Motomachi 7-33 Naka-ku, Hiroshima-shi, Hiroshima, Japan.
| | - Masashi Miguchi
- Department of Surgery, Hiroshima Prefectural Hospital, Ujinakanda 1-5-54 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Toshihiko Kohashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Kabeminami 2-1-1 Asakita-ku, Hiroshima-shi, Hiroshima, Japan
| | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Naoki Hirabayashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Kabeminami 2-1-1 Asakita-ku, Hiroshima-shi, Hiroshima, Japan
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Arakawa T, Hirata T, Koga K, Neriishi K, Fukuda S, Ma S, Sun H, Nagashima N, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Clinical aspects and management of inguinal endometriosis: A case series of 20 patients. J Obstet Gynaecol Res 2019; 45:2029-2036. [PMID: 31381248 DOI: 10.1111/jog.14059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/23/2019] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to describe the clinical presentation, diagnostic evaluation, and operative or medical management of inguinal endometriosis. METHODS In this study, we retrospectively reviewed 20 cases of inguinal endometriosis in our facility, particularly on the clinical characteristics, diagnosis, and surgical and medical treatment. RESULTS We retrospectively investigated the following items for each patient: age at diagnosis, surgical history, presence of extragenital endometriosis, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence and time to recurrence. We identified 20 cases of inguinal endometriosis in our facility. First, 75% of the patients had right inguinal endometriosis. Second, T1-weighted or fat-saturated T1-weighted images showed hyperintensity in the lesions in 17 patients (17/18 patients, 94.4%). Third, in 5 of 6 patients who underwent surgical therapy, we performed radical surgery to excise the inguinal lesion including the round ligament. One patient had disease relapse. Fourth, in 6 of 7 cases, dienogest effectively improved pain without significant adverse effects, but oral contraceptive was effective in 1 of 4 patients without significant adverse effects. CONCLUSION We retrospectively reviewed 20 patients with inguinal endometriosis in our facility. We have shown that magnetic resonance imaging can be a useful imaging modality to obtain a specific diagnosis of this disease. In addition, inguinal endometriosis can be managed with radical surgery to resect lesions including the round ligament and with hormonal treatment. In particular, dienogest ameliorated symptoms, which can be an option for patients who do not want surgery.
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Affiliation(s)
- Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Suke Ma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Maniglio P, Ricciardi E, Meli F, Tomao F, Peiretti M, Caserta D. Complete remission of cerebral endometriosis with dienogest: a case report. Gynecol Endocrinol 2018; 34:837-839. [PMID: 29676597 DOI: 10.1080/09513590.2018.1463362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The most recent evidences suggest the use of progesterone mimicking drugs for the treatment of endometriosis. Particularly, dienogest has been largely tested. However, the standard treatment of extra-pelvic endometriosis is debated. Particularly, cerebral localization of endometriosis is a very rare clinical condition. The surgical approach for such a particular disorder would consist in difficult procedures, thus leading to prefer the medical treatment. We hereby report the clinical case of a cerebral localization of endometriosis treated with dienogest who experienced a complete remission of the disease.
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Affiliation(s)
- Paolo Maniglio
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
| | - Enzo Ricciardi
- b Department of "Gynäkologie & Gynäkologische Onkologie" , Kliniken Essen-Mitte , Essen , Germany
| | - Federica Meli
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
| | - Federica Tomao
- c Department of "Scienze Ginecologico-Ostetriche e Scienze Urologiche" , "Sapienza" University of Rome , Rome , Italy
| | - Michele Peiretti
- d Department of "Scienze Ginecologico-Ostetriche" , "Azienda Ospedaliera Universitaria di Cagliari e Sassari" , Cagliari , Italy
| | - Donatella Caserta
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
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Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N, Katsikogiannis N, Sarika E, Courcoutsakis N, Tsiouda T, Gschwendtner A, Zarogoulidis K, Sakkas L, Baliaka A, Machairiotis C. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagn Pathol 2013; 8:194. [PMID: 24294950 PMCID: PMC3942279 DOI: 10.1186/1746-1596-8-194] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/23/2013] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvicdepending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinarytract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those.
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Affiliation(s)
| | | | | | - Paul Zarogoulidis
- Pulmonary Department, "G, Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Exohi 1100, 57010 Thessaloniki, Greece.
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Abstract
Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence.
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Crispi CP, de Souza CAP, Oliveira MAP, Dibi RP, Cardeman L, Sato H, Schor E. Endometriosis of the Round Ligament of the Uterus. J Minim Invasive Gynecol 2012; 19:46-51. [DOI: 10.1016/j.jmig.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 10/15/2022]
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Farooq U, Laureano AC, Miteva M, Elgart GW. Cutaneous endometriosis: diagnostic immunohistochemistry and clinicopathologic correlation. J Cutan Pathol 2011; 38:525-8. [PMID: 21352260 DOI: 10.1111/j.1600-0560.2011.01681.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cutaneous endometriosis is very rare, representing approximately 1.1% of cases of extrapelvic endometriosis. We report a case of a 44-year-old female with no prior surgical history who presented with multiple tan brown periumbilical nodules. Histopathological examination revealed multiple glandular structures in the dermis with surrounding stroma. Immunohistochemistry cinches the diagnosis, as CD10, estrogen receptor and progesterone receptor are strongly positive in our case. The mainstay of treatment of cutaneous endometriosis is surgical excision of the lesion.
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Affiliation(s)
- Uzma Farooq
- Kendall Medical Laboratory, Coral Gables, FL, USA.
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Silberman EA, Quildrian SD, Vigovich FA, Porto EA. [Inguinal endometriosis of the round ligament]. Cir Esp 2011; 89:469-70. [PMID: 21333972 DOI: 10.1016/j.ciresp.2010.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/27/2010] [Accepted: 07/03/2010] [Indexed: 11/16/2022]
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Abstract
BACKGROUND The diagnosis of inguinal endometriosis can be complex, and patients are often first operated by a general surgeon for a hernia. We present five cases of inguinal endometriosis in which primary surgery resulted in recurrence and a second correct procedure resulted in a cure. CASES Five patients with inguinal endometriosis, operated between 1996 and 2002, were seen for the recurrence of symptoms. All underwent excision of the extraperitoneal portion of the round ligament and pelvic exploration. In all cases, both pelvic and round ligament endometriosic lesions were confirmed at histology. No complications or recurrence of inguinal endometriosis occurred. CONCLUSION The complete excision of inguinal endometriosis must also include the extraperitoneal portion of the round ligament.
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Affiliation(s)
- Luigi Fedele
- Department of Obstetrics, Gynecology and Neonatology, Fondazione Policlinico-Mangiagalli-Regina Elena, University of Milan, Milan, Italy.
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