Hepatic endometriosis: a rare case and review of the literature.

Kai Liu,Songyang Liu,Yahui Liu,Wei Zhang,Bingfei Dong

doi:10.1186/s40001-015-0137-1

Kai Liu, Songyang Liu + Show 3 more

Open Access

https://doi.org/10.1186/s40001-015-0137-1

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Abstract

Hepatic endometriosis is one of the rarest disorders characterized by the presence of ectopic endometrium in the liver. To our knowledge, only 21 cases of hepatic endometrioma have been described in the medical literature. We report a case of a 36-year-old primiparous female with hepatic endometriosis forming a large cystic mass. The patient presented once with severe right quadrant pain as her only symptom and no history of endometriosis. Complete blood count and biochemical tests were normal. Abdominal ultrasonography and computed tomography scans suggested the presence of a 6.5 × 6.0 cm cystic mass in segment III of the liver. The mass was completely removed by local liver resection. The intraoperative frozen sections suggested a diagnosis of hepatic endometriosis. The diagnosis was confirmed through histological immunostaining without intrinsic abnormality. A preoperative diagnosis of hepatic endometriosis is made on the basis of considering the possibility in advance. Hepatic endometriosis should be considered in the differential diagnosis of a cystic liver mass despite conducting exhaustive investigations in the absence of characteristic clinical and radiological features. Histological examination is essential, and surgery remains the treatment of choice.

Highlights

Endometriosis is a benign condition most commonly noted in the uterus, fallopian tubes, ovaries, and local pelvic peritoneum [1]
Endometriotic lesions have been described in almost all other remote organs of the human body, including the omentum, gastrointestinal tract, peritoneum, operative scars, lymph nodes, umbilicus, skin, lungs, pleura, bladder, kidneys, pancreas, and even in males [3]
We describe the 22nd case of hepatic endometriosis and evaluate the current literature addressing the diagnosis of hepatic endometriosis focusing on advances in the clinical manifestation, pathogenesis, and diagnostic workup

Summary

Background

Endometriosis is a benign condition most commonly noted in the uterus, fallopian tubes, ovaries, and local pelvic peritoneum [1]. It affects approximately 10% of women of reproductive age and 2.5% of postmenopausal women [2]. The patient was diagnosed with a hepatic cystic mass in segment III of the left lobe. A preoperative computed tomography scan showed a well-circumscribed cystic lesion of 6.5 × 6.0 cm located in segment III (Figure 1). An exploratory operation was performed, which revealed a large cystic tumor occupying segment III of the liver (Figure 2). Biopsies were taken from the cyst wall, and the intraoperative frozen section histology suggested a diagnosis of hepatic endometriosis. Since no atypical cells were detected, we concluded the diagnosis to be benign intrahepatic endometriosis

Discussion

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