Abstract
We report the case of a patient diagnosed with primary umbilical endometriosis intending to discuss the diagnostic and therapeutic management of this rare disease. A 45-year-old woman suffering from a painful swelling located in the umbilical region, with intact and normal cutaneous aspect, came to our attention. Ultrasonography of the umbilical region showed a nodule with a nonhomogeneous echotexture pattern. Partial omphalectomy was performed under local anesthesia in day care setting surgery. Histology confirmed the diagnosis of umbilical endometriosis. Pre- and postoperative clinical controls showed no evidence for other endometriosis localization. No medical treatment was administered. No signs of recurrence were observed after 5 years from surgery. A review of the literature of the last 10 years was generated based on MEDLINE research, selecting some specific keywords. Several lesions can occur in the umbilical region, and endometriosis has to be ruled out even in patients without any surgery in their medical history. Surgery is the gold standard treatment for this condition: partial and radical omphalectomy are the two treatment options. We believe that given the significant psychological and aesthetical value of the umbilicus, surgical treatment has to be tailored and in case of a small endometrial umbilical nodule, partial omphalectomy (local excision of the umbilical endometrial nodule) with a 3 mm free border, even without adjuvant hormonal treatment, could ensure adequate and effective treatment.
Highlights
Endometriosis is a benign condition characterized by endometrial tissue found in anatomical localizations other than the uterus
The peculiarity of the case described is that the patient was diagnosed with primary umbilical endometriosis, without any suspicion of concomitant pelvic endometriosis and in the absence of previous surgery for either gynaecological disorders or caesarian section
Umbilical endometriosis is defined as secondary umbilical endometriosis (UE), which is due to iatrogenic dissemination and subsequent implant of endometrial cells during either laparoscopic or open surgical procedures [6]
Summary
Endometriosis is a benign condition characterized by endometrial tissue found in anatomical localizations other than the uterus. Primary UE, known as Villar’s nodule (who first described this scenario in 1886), arises spontaneously with not completely unravelled pathogenetic mechanisms, and it represents almost 75% of all cases of UE [6]; secondary UE can result from laparoscopic or open surgical procedures with umbilicus involvement. Both primary and secondary UE can be found as cutaneous or subcutaneous lesions [7].
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