Diagnosis Of Scar Endometriosis Research Articles

Caesarean scar endometriosis: how to make an accurate diagnosis.

Caesarean scar endometriosis is a rare condition characterised by the presence of endometrial tissue within a surgical scar following a caesarean section. A woman in her late 30s presented with a painful lump beneath her caesarean section skin scar, worsening during menstruation. Despite a previous incision and drainage procedure for a 'scar abscess', the symptoms persisted. Ultrasound imaging revealed a cystic lesion beneath the scar. A diagnosis of scar endometriosis was made, and surgical excision was performed. The patient remained symptom-free at 2-year follow-up postsurgery. Histopathology confirmed the presence of endometrial glands and stroma within the scar tissue. This case demonstrates that a reliable diagnosis of caesarean section endometriosis could be made with a triad of symptoms of a cyclic painful mass at the site of a caesarean section scar. Imaging is helpful in excluding other differential diagnoses. Diagnosis can be confirmed with histopathology and treated with complete surgical excision.

Cutaneous Endometriosis

Endometriosis affecting the skin is a very much rare surgical entity encountered almost exclusively in women of childbearing age. It commonly presents as a discoloring painful cutaneous swelling, the pain being most commonly a cyclical one occurring during menstrual bleeding. It often needs histopathological examination to arrive at a correct diagnosis. Otherwise, the diagnosis is usually presumptive from typical and atypical presentations and other supportive imaging investigations. Wide surgical excision is the gold standard curative treatment of choice. Nonsurgical treatment includes use of such hormonal agents as danazol or leuprolide, oral contraceptive pills, etc. which can’t definitely cure the patient from this nonfatal ailing disease. All other examples of benign and malignant cutaneous swellings like desmoid tumors, fibro-histiocytoma, dermatofibroma protuberans, papilloma, melanoma, visceral malignancies and many other types of fibromatosis are to be included in the differential diagnosis. These patients with cutaneous endometriosis need to be additionally evaluated for endometriosis elsewhere in the body especially in the pelvis and the abdomen proper, though no other tissue like brain, lungs, liver etc. are not immune to it. In women of childbearing age with abdominal or pelvic wall masses or an area of soft-tissue thickening at cross-sectional imaging in or very close to previous surgical scars, endometriosis is to be strongly suspected by the consulting radiologist. Imaging investigations like CT, USG, and especially, MRI may help in the diagnosis of scar endometriosis, but it is only the biopsy that is definitely confirmatory. KYAMC Journal. 2022;12(04): 243-249

Case series of scar endometriosis- post caeserean section: A diagnostic pitfall

The presence and growth of ectopic functional endometrial tissue outside the uterus is called endometriosis among which scar endometriosis is rare and difficult to diagnose. It occurs as a result of obstetrical and gynecological surgeries and can be confused with other surgical conditions.We reviewed the case records of patients with the diagnosis of scar endometriosis seen in our hospital from 2015 to 2018.We found six patients of scar endometriosis. The median age of the patients was 28.5 years (range 20-31 years) and median interval from symptoms to treatment was 4 years (range 2-6 years). Four patients had first presented to either the surgery or dermatology physicians. The most common complain being cyclical pain and swelling at local site. Patients underwent wide excision of the mass with no recurrence of symptoms at a follow up ranging from 9 months to 12 years.Confirmation of the diagnosis is histopathology with wide surgical excision being the treatment of choice. We have discussed the pathogenesis, diagnosis and treatment of this condition. Imaging techniques and FNAC are indicated towards better diagnostic approach and avoid confusion with other conditions. Medical treatment is helpful in selected cases only. After studying and presenting this paper we would like to highlight on such a rare condition and prevent its misdiagnosis.

Scar endometriosis: A rare case report

Endometriosis is condition in which presence of functioning endometrial tissue outside the uterine cavity. It is of two types, pelvic and extrapelvic types. Scar endometriosis is a rare entity and extrapelvic type and very difficult to diagnose. The incidence of scar endometriosis is 0.03% to 0.15%. It is commonly occur after obstetrical and gynecological surgeries. We report a rare case of scar endometriosis in 28 years Indian female who presented with anterior abdominal wall swelling and pain in the mass during menstrual cycle since 1 year at lower abdominal cesarean section site after 2 years of surgery. The purpose of presenting this case is to discuss clinical features, incidence, pathogenesis, and histopathological findings. Histopathology plays a key role in the diagnosis of scar endometriosis.

Utility of cell block preparation for preoperative diagnosis of scar endometriosis

Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cesarean scar endometriosis is rare with an incidence varying from 0.03% to 0.5%. Fine-needle aspiration cytology (FNAC) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses which are often misdiagnosed. We report a case of cesarean scar endometriosis presenting as a tender abdominal nodule which was diagnosed by FNAC and confirmed by cell block preparation with progesterone receptor and CD10 positivity on immunohistochemistry. The use of cell blocks has been widely advocated in the diagnostic workup of patients with masses amenable to fine-needle aspiration (FNA) since they provide diagnostic architectural information which complement FNA smears.

Diagnosis and Treatment of Post-Caesarean Scar Endometriosis

Endometriosis is a common disease that involves approximately 10–15% of women of reproductive age. It is defined as an ectopic implantation of endometrial tissue outside the uterusIt is frequently detected in the pelvic organs, such as the peritoneum, the ovaries, the pouch of Douglas and the uterosacral ligaments.The possible sites are, in the order of frequency, the abdominal wall, the bowel, the peritoneum, the omentum, the umbilicus, the hernial sacs, the bladder, the kidney, the lungs, the pleura and the extremities.The cause of endometriosis remains controversial and gives rise to many theories, such as the role of the immune system with the drop in the regulatory capacity of natural killer cells and the mechanical transportation of the cells after gynaecological procedures. The diagnosis of scar endometriosis based solely on data from the medical history and clinical examination is difficult. Echography and colour Doppler methods are the use full tools for the treatment.

Cytodiagnosis of scar endometriosis

Sir, Many non-neoplastic and neoplastic lesions that occur on anterior abdominal wall can be confused with scar endometriosis on clinical grounds. Non-neoplastic lesions include hematoma, suture granuloma, abscess, incisional hernia, focal fibrosis, desmoid tumor, keloid and melanocytic nevus. Neoplasms to be differentiated may be primary (benign or malignant) or metastatic (sister Mary Josephs nodule). Scar endometriosis can be differentiated from most of these only on the basis of detailed history about the swelling, careful clinical examination and characteristic cytological features.[1] We present a case that initially posed a problem in diagnosis as patient could not be seen by the reporting cytopathologist and important clinical indicators were missed. A 35-year-old female patient presented with the complaints of gradually increasing swelling and pain in the infra-umbilical region since last 3 years. Patient did not have swellings at any other site or any other complaints. She gave history of two full term deliveries by cesarean section; her last childbirth was 5 years back. A 3 cm × 3 cm, firm non-mobile swelling was present on anterior abdominal wall below umbilicus. Skin over the swelling was adherent and discolored [Figure 1]. Clinical diagnosis of soft-tissue tumor was offered and cytology study was advised. Abdominal sonography of patient revealed a poorly defined lesion in the subcutaneous plane with minimal vascularity and without peritoneal communication. The impression given was abdominal wall desmoid. Figure 1 Anterior abdominal wall swelling 3×3 cm with discoloured overlying skin near a scar mark Fine needle aspiration cytology smears from the tender infraumbilical swelling showed high cellularity of glandular and stromal cells [Figure 2]. Glandular cells were arranged in tight clusters and sheets, had round nuclei with uniform chromatin pattern [Figure 3]. Altered blood, debris and foamy macrophages were seen in the background [Figure 4]. Some macrophages showed presence of hemosiderin pigment. Figure 2 Bimodal population of endometrial glandular and stromal cells seen as compact fragments in haemorrhagic background (PAP ×100) Figure 3 Honeycomb sheets of glandular cells without nuclear atypia (PAP ×400) Figure 4 A group of macrophages in the background of blood and debris (PAP ×400) Inset-Hemosiderin laden macrophage High cellularity in a dirty background observed in cytology smears initially puzzled us. After carefully examining the swelling and eliciting, the history of increase in the size of the swelling and pain during the menstrual cycle: Noticing the location of the swelling near a scar mark and Appreciating the bland nuclear pattern in glandular and stromal cells in all the smears diagnosis of scar endometriosis could be given. Endometriosis is defined as the presence of functioning endometrium outside the uterus. Occurrence of endometriosis is described usually in the pelvic region and in many unusual and uncommon extra pelvic sites.[2] Only cutaneous and subcutaneous endometriosis are easily accessible to cytological study. Scar endometriosis-a form of cutaneous endometriosis is generally seen in women of reproductive age group.[3] History of catamenial exacerbation, i.e., increase in pain and tenderness in a lump during menstruation and location of a firm, tender swelling near a scar either of C section, laparotomy, hysterectomy or episiotomy point toward the diagnosis of scar endometriosis.[4] On radiological examination, the swelling is in the subcutaneous plane with no intraperitoneal communication. Characteristic cytological features include good cellularity of glandular and stromal cells with uniform, bland nuclei in the background of altered blood, debris and foamy macrophages, some of them containing hemosiderin. The cytological features of endometriosis are related to cyclic hormonal changes. In proliferative phase, glandular cells are seen as honeycomb sheets and tight clusters, have round or oval nuclei with evenly distributed chromatin. Stromal cells form syncytial clusters and have plump spindle nuclei with fine chromatin. In the secretory phase, glandular cells show an increase in cell size and microvacuolation while stromal cells reveal abundant cytoplasm.[4] Diagnosis of endometriosis is not always straight forward. Difficulties arise when it arises in unusual clinical setting and without characteristic bimodal pattern in the smears. When atypical cytological features are seen in smears histological examination is advisable in order to differentiate endometriosis from malignancy.[5] Fine needle aspiration cytology remains a reliable and relatively atraumatic investigation for primary pre-operative diagnosis in most cases if the cytopathologist is aware of the entity and interprets the cytological features in the light of clinical findings of: A reproductive age group female with discolored swelling near a scar mark on anterior abdominal wall History of catamenial exacerbation Location of swelling in the subcutaneous plane on radiological examination. Cytology is a method of choice to monitor treatment and possible malignant transformation in a case of endometriosis.

Pre-operative Diagnosis of Scar Endometriosis by Aspiration Cytology

Purpose Endometriosis is a fairly common disease found in a variety of extra-uterine locations. Abdominal wall scar endometriosis usually presents as a cutaneous or subcutaneous mass which can be investigated easily by the noninvasive method of fine needle aspiration cytology (FNAC). Methods FNA was performed by a cytopathologist on three patients presenting with varying sized swellings near the cesarean section scar. Results The cytologic smears revealed a combination of epithelial cells, stromal cells, and variable number of hemosiderin-laden macrophages. A diagnosis of endometriosis was provided on FNAC and later confirmed on histopathology. Conclusions FNAC is a valuable, cost-effective. and safe tool for diagnosing scar endometriosis and thus permits correct management of the patient.

Scar endometriosis – A series of six patients

Introduction Scar endometriosis is a rare form of extrapelvic endometriosis that is usually confused with other surgical or dermatological conditions leading to delay in diagnosis. Methods We reviewed the case records of patients with the diagnosis of scar endometriosis seen in our hospital from January 1996 to December 2008. Results We found six patients of scar endometriosis in 13 years making it one of the rare conditions. The median age of the patients was 32.5 years (range 28–37 years) and median interval from symptoms to treatment was 2 years (range 1–6 years). Four patients had first presented to either the surgery or dermatology physicians. Cyclic pain and swelling at local site was the most common presenting symptoms. All patients underwent wide excision of the mass with no recurrence of symptoms at a follow up ranging from 9 months to 12 years. Conclusions Increasing awareness of this condition among doctors can help in early diagnosis and treatment with gratifying results.

Endometriose de cicatriz cirúrgica: estudo retrospectivo de 72 casos

PURPOSE: to identify the incidence and associated factors of surgical scar endometriosis. METHODS: a retrospective cohort observational study performed from the medical records of female patients attended at the Clinical Hospital of Univesidade Federal de Minas Gerais (UFMG) with histopathological diagnosis of scar endometriosis from May 1978 to December 2003. RESULTS: a total of 72 patients were included in the study. The incidence of scar endometriosis after cesarean section was significantly higher than after episiotomy (0.2% and 0.06%, respectively; p<0.00001) with relative risk of 3.3. The women’s age, when diagnosed, ranged from 16 to 48 years old, (mean=30.8 years old). The scar location varied according to the previous surgery: 46 scars after cesarean sections, one after hysterectomy and one after abdominal surgery (48 lesions in the abdominal wall); 19 scars after episiotomy, one because of relapse and two after pelvic floor surgeries (22 pelvic wounds); two women had not been submitted to previous gynecological surgery (one umbilical endometrioma and one lesion in the posterior vaginal wall). Pain was the most frequent symptom (80%), followed by a node (79%) and, in more than 40%, the pain and the node suffered modification with menstruation. Other less frequent complaints were: dyspareunia, secondary infertility, pelvic pain, dysmenorrhoea, scar secretion, menorrhagia pain when evacuating. The mean time observed between the surgery and the beginning of the symptoms was of 3.7 years. The average size of the endometriomas was 3.07 cm. The diagnosis based on clinic evaluation was correct in 71% of the cases. The choice of treatment in all the cases was the surgical excision. In only one incident there was relapse and new intervention. CONCLUSIONS: scar endometriosis is a rare situation originated, in most cases, after obstetrical surgical procedure, with higher risk after cesarean section. It is a highly suggestive clinical condition, with a rare necessity of complementary diagnostic procedures, and the best treatment choice is the surgical excision.

Scar endometriosis: An unusual cause of lower abdominal pain in an adolescent

A 16-year-old primigravida presented with a 3-year history of right lower quadrant pain. Physical examination revealed a mass lateral to the edge of a low transverse abdominal incision from her cesarean section. Following surgical excision, histological examination revealed tissue consistent with endometriosis. The patient was discharged without complications with a diagnosis of scar endometriosis.