Abdominal wall endometriosis versus desmoid tumor - a challenging differential diagnosis

A Typical Presentation of Cesarean Section Scar Endometriosis: A Case Report

Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynecological surgeries. Although the symptoms are non-specific and varying, scar endometriosis classically presents with cyclic pain at the site of incision during menstruation. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. Here, we present a case of extragonadal endometriosis at the cesarean section scar. The patient presented with cyclical menstrual pain at the surgical incision. Our aim in this case report is to present the approach to diagnosing such a condition with the associated presentation and histological findings.

Efficacy of cognitive behavioral therapy after the surgical treatment of women with endometriosis: A preliminary case-control study

BACKGROUND

Regardless of unique status or symptoms, any woman with endometriosis is at risk of developing mental health issues such as anxiety and depression. Cognitive behavioral therapy (CBT) is an effective psychological treatment for depression, anxiety, and stress. The objectives of the study were to see whether usual care combined with CBT improves depression, anxiety, and stress in patients after surgery for endometriosis as compared to usual care alone.

METHODS

Patients aged 18 to 50 years old with endometriosis who were scheduled for surgery were received usual care (Chinese martial arts) with CBT (1 pre-surgery and 6 post-surgery CBT sessions; Case or Intervention group, n = 48) or usual care only (Control group, n = 48). The demographic characteristics questionnaire was given to all individuals. Depression, anxiety, and stress were evaluated at baseline (within 24 hours after admission to the hospital) and postintervention (immediately before discharged) in both groups using the Chinese short version of Depression Anxiety and Stress scale (DASS-21).

RESULTS

At postintervention DASS-21 scores for depression, anxiety, and stress of the case group and the control group were decreased as compared to baseline (P < .0001 for all). At postintervention DASS-21 score for anxiety of the case group was decreased compared to the control group (P = .0091). Usual care plus CBT significantly increased the number of females with no symptoms of depression as compared to baseline at postintervention(s) (P = .0356). At postintervention(s), there was no female with extremely severe depression in both groups. Usual care plus CBT significantly decreased the number of females with symptoms of extremely severe anxiety as compared to baseline at postintervention(s) (P = .035). Unlike the control group, in the case group, there were no females with extremely severe stress at postintervention.

CONCLUSIONS

females with endometriosis who had surgery reported high levels of depression, anxiety, and stress at the time of hospital admission. Patients with endometriosis can benefit from CBT.

Abdominal wall endometriosis misdiagnosed as a desmoid tumor: A case report

Introduction

Abdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT.

Presentation of case

A healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient's post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected.

Discussion

The current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis.

Conclusion

Since AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.

•

In presence of abdominal wall mass in reproductive women, diagnosis is challenging.

•

Desmoid tumors and abdominal wall endometriosis can be misdiagnosed.

•

Both diseases share similar clinical signs and aspecific imaging exams.

•

Final pathology of the mass can state the precise diagnosis.

Case Report: Two Cases of Abdominal Aggressive Fibromatosis That Mimicked Abdominal Wall Endometriosis and Review of Literature

Background: Abdominal aggressive fibromatosis (AF) can be confounded with abdominal wall endomentriosis (AWE) because they share considerable similarity. Because of the different patient prognoses and treatment strategies available, accurate pre-operative diagnosis is important. Case Presentation: We here report two cases of abdominal masses presenting as periodic changes in tumor sizes, which occurred in correlation with the menstrual cycle. The clinical findings were highly suggestive of AWE. However, the final pathological findings revealed AF. The estrogen receptor and progesterone receptor expressions were negative in the two cases. The differences between the two diseases have been discussed in detail. Conclusion: A diagnosis of AWE should be scrutinized closely if the patient does not complain of cyclic pain. Fine-needle aspiration cytology is a suitable tool for pre-operative evaluation.

Diagnosis of scar endometriosis on aspiration cytology and cellblock: Myth or reality

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It can occur both in the pelvic and extra pelvic regions. Abdominal scar endometriosis is a rare type of extra pelvic endometriosis that occurs after surgery involving the uterus. In the post-cesarean section, the development of scar endometriosis is a rare event and the diagnosis of scar endometriosis is usually confirmed after surgical excision and histopathological examination. We present a case of an abdominal lump in a 26-year-old female with a myriad of clinical differential diagnoses, which was rendered a confirmed diagnosis of scar endometriosis with the help of fine-needle aspiration cytology and cell block aided with immunohistochemistry.