Extrapelvic Endometriosis Research Articles

Ultrasound-guided microwave ablation for symptomatic abdominal wall endometriosis and treatment response evaluation with contrast-enhanced imaging: The first experience.

Abdominal wall endometriosis (AWE) is a relatively uncommon condition associated with diagnostic and therapeutic difficulties among all the extra pelvic endometriosis. The main therapies include surgery and oral contraceptive administration. Percutaneous cryoablation and high intensity focused ultrasound (HIFU) are also proven to be valid alternatives. Microwave ablation (MWA) as one of the thermal ablation methods has not been applied in the treatment of AWE yet. Herein the feasibility of ultrasound (US) -guided MWA for AWE was explored and treatment response evaluation was carried out using contrast-enhanced imaging. Three consecutive patients who underwent US-guided MWA for AWE with typical symptoms were included in this retrospective study. US, magnetic resonance imaging (MRI), laboratory tests, and US-guided core-needle biopsy were conducted for pre-treatment assessment and ruling out malignancy. The interventional procedure was carried out under local anesthesia with MWA and the output power was 60w. Post-treatment contrast-enhanced ultrasound (CEUS) was performed to evaluate the instant treatment response. The follow-up intervals were 1 month, 6 months, and 12 months after treatment. The clinical symptoms and condition of AWE lesions were recorded in each follow-up. The MWA procedure was completed in all the patients with no blood perfusion inside each lesion by instant CEUS after treatment. The mean ablation time was 687 seconds (s) for a single patient (ranged from 660s to 742s). Clinical symptoms were relieved evidently at the end of the follow-up. The pain according to the visual analogue scale (VAS) decreased from 4-6 before treatment to 0-2 after treatment. Mild to moderate complications included slightly abdominal pain and fat liquefaction occurred. In terms of technical outcomes, the volume of all six lesions reduced in different degrees at the end of follow-up (ranged: 16.6% to 100%). US-guided MWA may be a feasible and promising approach for symptomatic AWE.

A Case of Primary Endometriosis Associated With an Umbilical Hernia

Endometriosis is a common gynecological disease that mainly influences pelvic organs. However, extra-pelvic endometriosis is considered less prevalent. Here, we present a case study of umbilical endometriosis associated with an underlying hernia. It is known that the incidence of such a case is very rare and its diagnosis is challenging. Surgical excision of this type of lesion with a repair of the hernia is considered the preferred management approach. In this case, a 40-year-old female was admitted to the hospital with cyclical umbilical bleeding for one year. The bleeding would start with her menstruation and continue throughout the menstrual period. Initial diagnosis was made by physical examination and ultrasound imaging. Treatment options were discussed with her and she accepted to undergo surgical wide excision of the umbilical lesion with a repair of the hernia. Diagnosis was further confirmed by a histopathological study of the lesion tissue specimen. Also, a referral to a gynecologist did not report any abnormality or pelvic disease, and the patient was discharged well from the hospital.

PRIMARY UMBILICAL ENDOMETRIOSIS: A RARE CASE REPORT

Umbilical endometriosis is a rarest form of extrapelvic endometriosis, incidence being 0.5% - 1% of all extrapelvic endometriosis. In primary umbilical endometriosis there is no history of any previous abdominal and pelvic invasive procedures. Most patients present with an umbilical nodule which is associated with cyclical pain and bleeding from the lesion during menstrual cycle. It is mainly diagnosed clinically and is conrmed by histopathology. Surgery is the treatment of choice. Pre and post operative hormonal supplementation results in better outcome

Endometriosis of the Rectus Abdominis Muscle a Case Report and Review of the Literature

Endometriosis is defined as the presence of ectopic functioning endometrial tissue outside the uterine cavity, the abdominal wall, especially the rectus abdominis muscle, is an uncommon site of extra pelvic endometriosis. It usually develops in a previous surgical scar. We propose during this work and through a case of the rectus abdominis endometrioma reported at the service of visceral surgeryI HMIMV, to review in a rather exhaustive, specific epidemiological, clinical, para clinical and therapeutict of the parietal endometriosis, in the light of contemporary literature.

Endometriosis in para-aortic lymph node resembling a malignancy: a case report and literature review

BackgroundEndometriosis is a common benign gynecological disease characterized by growing-functioning endometrial tissue outside the uterus. Extra-pelvic endometriosis, which accounts for approximately 12% of endometriosis, is more challenging to diagnose because of its distance from the pelvic organs. Halban's theory of benign metastasis indicates that endometrial cells can appear in extra-pelvic organs via lymphatic and blood vessels, but endometrial lymph node metastasis cases are still rare. We report a case of endometriosis in a para-aortic lymph node whose clinical behavior mimicked a malignancy.Case presentationA 52-year-old perimenopausal woman underwent laparoscopic hysterectomy plus bilateral salpingectomy (the patient insisted on the preservation of her ovaries) at a local hospital 2 years earlier because of adenomyosis. The patient presented with a complaint of low back pain to the gastrointestinal outpatient department of our hospital. The carbohydrate antigen 125 (CA125) was abnormally elevated at 5280.20 U/ml, human epididymis 4 (HE4) was 86.0 pmol/L, while other tumor markers were normal. Serum female hormone results were in the postmenopausal range, and her gastroenteroscopy showed no abnormalities. Moreover, both enhanced magnetic resonance imaging and positron emission tomography-computed tomography showed a high possibility of a retroperitoneal malignant lymph node (metastasis possible, primary site unknown). One week after admission, she underwent laparoscopic exploratory surgery, during which we observed normal shape and size of both ovaries while the left ovary was cystic-solid. After opening the retroperitoneal space, an enlarged lymph node-like tissue measuring 8 × 4 × 3 cm3 was found near the abdominal aorta. When the surrounding adhesions were separated, lymph node-like tissue was poorly demarcated from the abdominal aorta and renal artery. Some lymph node samples and left ovary were sent for intraoperative frozen section, which revealed benign lesions, similar to endometrial tissue. The lymph node tissue was then excised as much as possible, and the second set of intraoperative frozen sections showed high probability of endometrial tissue. The final histopathology and immunohistochemistry staining reached a diagnosis of para-aortic lymph node endometriosis. Gonadotropin-releasing hormone antigen treatment was recommended every 28 days because of the high preoperative CA125 and imaging-based suspicion of malignancy. The serum CA125 subsequently decreased to normal levels, and no para-aortic lesions were detected on abdominal enhancement CT. She is being followed up regularly.ConclusionIt is known that the incidence of lymph node metastasis in pelvic endometriosis is relatively rare. Our report shows that endometriotic tissue can metastasize via the lymphatic route and suggests that endometriotic tissue has the characteristics of invasion and metastasis.

Beyond borders: A case report of small bowel obstruction secondary to undiagnosed florid endometriosis.

Introduction and importanceEndometriosis is a gynecological condition referring to the presence of endometrial tissue outside the endometrium with the potential of progressing to malignancy. It mostly affects pelvic organs; however, it has been described beyond the pelvis. In 10% of cases it occurs in the bowel, mostly rectum and sigmoid. Involvement of the small bowel is rare. Here we report endometriosis of the terminal ileum and appendix in a patient with no previous diagnosis of endometriosis.Case presentationWe describe a case of a 39-year-old-female who presented with abdominal pain, nausea and vomiting to the emergency department. This was on background history of intermittent abdominal pain every 2 weeks for the previous 5 months. Further investigation with computed tomography (CT) of the abdomen and pelvis showed small bowel dilatation with a polypoidal lesion obstructing the terminal ileum. On colonoscopy, no intraluminal lesions were identified in the terminal ileum. The patient underwent right hemicoloectomy. Histopathological results revealed endometriosis. The patient had uneventful recovery post-operatively and at her follow-up review at 4 weeks and 2 months from surgery.DiscussionThe presentation of endometriosis of the bowel is highly variable and difficult to diagnose pre-operatively. Due to lack of specific diagnostic measures, surgical resection and histology can be the only reliable way for first-time endometriosis diagnosis presenting as small bowel obstruction.ConclusionExtra-pelvic endometriosis should be considered as the cause of small bowel obstruction in the absence of other causes of bowel obstruction in young female patients.

ESHRE guideline: endometriosis.

ESHRE guideline: endometriosis.

Endometriosis arising in a cesarean section scar: A case report.

Introduction and importanceScar endometriosis is an uncommon variant of extra pelvic endometriosis, which develops at the scar site of previous abdominopelvic surgery and is seen in women during their reproductive period.Case presentationWe report a 38-year-old female who presented with a nine-months history of a painful ulcerative mass that developed on a cesarean section scar. The mass was removed by a wide excision and confirmed by histology to be endometriosis.Clinical discussionWide surgical resection of ectopic endometriosis is the treatment of choice. It is usually curative and ensures the confirmation of the diagnosis.ConclusionCesarean section scar endometriosis can undergo malignant transformation. This case highlights the need for early detection and treatment.

Laparoscopic posterior pelvic exenteration for clear cell adenocarcinoma arising in an episiotomy scar

Malignant degeneration of endometriosis is a very rare event, especially when it develops in an episiotomy scar. A 53-year-old woman with an enlarged perineal mass presented to the hospital. She had undergone vaginal delivery with episiotomy twice. Imaging analyses showed a mass involving the levator ani muscle apart from the rectum, with lymph node metastases to the right inguinal and internal iliac regions. A biopsy specimen of the right inguinal lymph node revealed poorly differentiated adenocarcinoma. She underwent neoadjuvant chemotherapy according to the treatment strategy of anal fistula cancer. Laparoscopic posterior pelvic exenteration and pelvic lymph node dissection with anterior inguinal node dissection was performed, along with perineal reconstruction. Pathological examination revealed clear cell adenocarcinoma with lymph node metastases, derived from extrapelvic endometriosis in the episiotomy scar. She was treated with adjuvant chemotherapy according to the treatment strategy of vulvar cancer, and showed no evidence of recurrence after 15 months of surgery.

Cesarean scar endometriosis: A case report

Endometriosis is a chronic gynaecological disorder where presence of functional and morphological endometrial gland present outside the uterine cavity. Cesarean scar endometriosis is an unusual manifestation of extra pelvic endometriosis. Here, we report a case of caesarean scar endometriosis diagnosed after 6 years of cesarean delivery and was treated by surgical wide enbloc excision under spinal anaesthesia. Main aim is to increase awareness of this entity. Keywords: Cesarean scar endometriosis (CSE); Surgical wide En Bloc excision; Sclerotherapy

Ring-Enhancing Lesion: A Rare Computed Tomographic and Ultrasounographic Finding of Extrapelvic Endometriosis.

Endometriosis is a benign gynecological disorder defined as the presence of endometrial glands and stroma in places other than the uterus. It can be pelvic or extrapelvic. The diagnosis of extrapelvic endometriosis can be a challenge for emergency physicians due to the low prevalence of and limited information on blood tests and radiologic findings. Surgical excision is the only option for definitive diagnosis and treatment. Ultrasonography still has a fundamental role in the majority of endometriosis cases in atypical sites.

Near Infrared Imaging with Indocyanine Green for Resection of Diaphragmatic Endometriosis

Study Objective To describe the key principles of successful extra pelvic endometriosis excision, highlighting diaphragmatic endometriosis, and the potential role of indocyanine green and near infrared imaging. Design Case Report. Setting Multidisciplinary surgical case at an academic institution using robotic and near infrared technology. Patients or Participants Thirty-three-year-old para zero with chronic pelvic pain and laparoscopically proven stage IV endometriosis, new onset right shoulder pain and known diaphragmatic disease. Interventions Preoperative MRI followed by robotic-assisted laparoscopic diaphragmatic endometriosis excision using near infrared technology. Measurements and Main Results Complete excision of endometriosis was achieved with resolution of patient's pain. Conclusion Successful diaphragmatic endometriosis excision requires appropriate pre-operative imaging, coordination of a multidisciplinary team, and can be aided by the use of indocyanine green and near infrared imaging. To describe the key principles of successful extra pelvic endometriosis excision, highlighting diaphragmatic endometriosis, and the potential role of indocyanine green and near infrared imaging. Case Report. Multidisciplinary surgical case at an academic institution using robotic and near infrared technology. Thirty-three-year-old para zero with chronic pelvic pain and laparoscopically proven stage IV endometriosis, new onset right shoulder pain and known diaphragmatic disease. Preoperative MRI followed by robotic-assisted laparoscopic diaphragmatic endometriosis excision using near infrared technology. Complete excision of endometriosis was achieved with resolution of patient's pain. Successful diaphragmatic endometriosis excision requires appropriate pre-operative imaging, coordination of a multidisciplinary team, and can be aided by the use of indocyanine green and near infrared imaging.

Endometriosis de región mandibular: reporte de caso

Introduction: Endometriosis is a chronic gynecological disease, which refers to the presence of endometrial glands and stroma outside the uterine endometrium. This entity has a frequency of 10 to 15% in women of reproductive age, and its most common site of presentation is the ovary. At the extrapelvic level, the most common location is the gastrointestinal and genitourinary location. However, it can occur in any location. Presentation: The case of a 40-year-old female patient with a face tumor in the mandibular region is described, presenting with a disease time of 2 years. Among the important antecedents, two months before the appearance of the tumor region, the patient underwent endodontic surgery of a lower molar tooth, contiguous to the mandibular. Likewise, one month before the appearance of the tumor, the patient underwent an exploratory laparoscopy for electrofulguration of endometriotic foci in the uterine myometrium. The patient underwent a surgical resection of the tumor in the mandibular region described; and after reviewing the histological and immunohistochemical slides at the institution, the diagnosis of endometriosis was established. Conclusion: Extrapelvic endometriosis is rare in our country, and its diagnosis requires experience and visual training in the recognition of normal endometrial tissue. The presentation of this case was considered important because it would be the first case reported in Peru and in the world, of an endometriosis located in the mandibular region.

A rare case of postmenopausal inguinal endometriosis

Endometriosis is a condition in which endometrial cells are located outside the uterine cavity, mostly in the abdominal cavity and the peritoneum. It is commonly located in the ovaries, bowel, and pelvic cavity. Sometimes, it can be located in the extrapelvic region also. Inguinal endometriosis is a rare form of extrapelvic endometriosis. Most of the inguinal endometriosis present around 30–40 years of age with a prior history of gynecological or abdominal wall surgery. Our patient presented with inguinal endometriosis in the postmenopausal period without a history of prior surgery. Moreover, she did not present with classical symptoms of abdominal wall endometriosis. Inguinal endometriosis can be considered as one of the differential diagnoses in postmenopausal women even without classical symptoms of endometriosis.

Extra-pelvic endometriosis presenting as recurrent hepatic cyst: case report and literature review

Hepatic endometriosis is a very rare form of endometriosis first described by Rokitansky in 1986. To our knowledge, 42 cases of hepatic endometriosis have been reported in the literature till date. The condition offers a diagnostic challenge owing to its variable presentation on imaging and the need for histological and immunohistochemical evidence for a definite diagnosis. We hereby present the 43rd case of ectopic endometrium in the liver of a 30 years old, multiparous female who presented with fever and pain in the right hypochondrium. Radiological imaging suggested a cystic lesion which was managed laparoscopically. Histopathology and immunohistochemistry findings came out to be consistent with endometriosis. The case highlighted the importance of considering endometriosis as a differential in all women irrespective of age and previous history of endometriosis.

Laparoscopic Transillumination for Extrapelvic Superficial Abdominal Wall Endometriosis

A recent systematic review showed that extrapelvic endometriosis may not be rare [1]. Within the primary parietal endometriosis abdominal sites, umbilical is the most common type of cutaneous endometriosis [1]. The clinical presentation usually includes an umbilical mass, pain, or cyclic bleeding [2]. Presurgical marking techniques with magnetic resonance imaging or ultrasonography are important for treatment planning, and complete surgical resection results in a cure 95% of the time [3,4]. We describe a technique for intraoperative marking of the superficial abdominal wall implants.

Recurrent chest pain as a rare presentation of extra-pelvic endometriosis.

Periodic chest pain, with bloody pleural effusion should raise the suspicion of pleural endometriosis as a well‐known, but a rare condition in clinical practice.

Malignant transformation of hepatic endometriosis: a case report and literature review

BackgroundExtrapelvic endometriosis is defined as the presence of ectopic endometrial tissue in structures outside the pelvis. Although extra-pelvic endometriosis is generally considered benign conditions, malignant potential within endometriotic foci occurs even after definitive surgery. Malignant transformation of hepatic endometriosis is extremely rare. Preoperative diagnosis of this cancer is difficult, and no guidelines on the optimal management currently exist. Here, we present a case report of malignant transformation of hepatic endometriosis and a brief literature review to highlight the current knowledge of the prevalence, clinical features, diagnosis, and management of this condition.Case presentationA 50-year-old woman with a 2-year duration of progressive right upper quadrant abdominal pain was admitted to the hospital. She underwent hysterectomy and bilateral salpingo-oophorectomy for benign conditions 4 years prior. Tumor markers demonstrated elevated carbohydrate antigen (CA)-199 112U/mL (normal range: 0–35U/mL) only. Radiological imaging suggested the presence of a 10.7 × 7.7-cm mass in the right lobe of the liver extending to the diaphragm. The intraoperative frozen sections suggested malignant tumor. Right hepatectomy with infiltrating diaphragm resection was performed. The final pathology with immunohistochemistry staining confirmed endometrioid adenocarcinoma in the liver originating from preexisting hepatic endometriosis. After the multidisciplinary team meeting, the consensus was surgery followed by adjuvant chemotherapy. To our knowledge, this is the first case of Chinese woman of a malignant liver tumor originating from endometriosis ever reported by reviewing the current English medical literature.ConclusionThough rare, extrapelvic endometriosis-associated cancers should be considered as differentiated diagnosis even after hysterectomy and bilateral salpingo-oophorectomy. This case highlights the importance of collaborative efforts across multiple disciplines for accurate diagnosis and appropriate treatment of malignant transformation of hepatic endometriosis.

Scar endometrioma in previous caesarean section: Two case reports with review of literature

Scar endometriosis is one of the rare types among the extra pelvic endometriosis which is challenging to diagnose. Cystic or solid nodular mass caused by endometriosis are called as endometrioma. It commonly follows obstetrical and gynaecological procedures where there are endometrial manipulations. The symptoms typically involve abdominal wall pain near scar site. Here we report two cases of scar endometrioma involving rectus sheath following caesarean section which are pathology confirmed with a classical clinical presentation and image findings on ultrasonography. By presenting these cases, we emphasize on evaluation, diagnosis, and treatment of caesarean scar endometrioma and increase awareness on this entity.

Long term follow-up of inguinal endometriosis

BackgroundInguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital.Case presentationThree patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints.ConclusionsInguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.