A case of inguinal endometriosis with difficulty in preoperative diagnosis

Abstract

An unusual case of endometriosis involving the right round ligament in a 40-yearold woman is presented. After giving birth to two children, she first noticed a tender mass in the right groin at the age of 36. It didn't change in size but pain appeared at the age of 38, disturbing her daily life. A poorly circumscribed elastic hard mass, measuring 3cm in diameter, was palpable in her right inguinal region. Magnetic resonance imaging demonstrated a 2×3 cm mass in the right inguinal canal. At operation, a mass was found to be in continuity with the round ligament at the inguinal canal. Histological diagnosis was endometriosis. After operation, she was completely relieved of pain. It is important to include endometriosis in the differential diagnosis for painful inguinal masses in women of childbearing age.

Endometriosis of the inguinal region: Magnetic resonance imaging (MRI) findings

“…The first reported case of endometriosis affecting the extraperitoneal portion of the round ligament was described by Cullen 5 in 1896, and its incidence was found to be 0.6% among women suffering from endometriosis 6 . Uzunlar et al reported 40 cases in the literature, and we were able to find a further 7 cases published in English 7–13 …”

“…Both showed a poorly circumscribed mass, which had the same intensity as muscle on T1W images, and higher intensities with partial low intensities on T2W images. One author described a mosaic pattern of enhancement after gadolinium injection 8 …”

Fine Needle Cytology of Endometriosis

“…[10][11][12][14][15][16]22 Moreover, rare cases of endometriosis have been described in uncommon sites, such as rectovaginal septum, urinary bladder, hernia sacs and umbilicus. 4,[6][7][8][9] In these cases FNC may be the only diagnostic tool in the pathologic evaluation of these lesions and provides a rapid and accurate preoperative diagnosis. Such a technique can in fact obviate the need for an invasive diagnostic procedure and resolve the differential diagnosis of palpable lesions of the abdominal wall.…”

“…Moreover, we desired to discuss briefly the clinical implications and drawbacks of a cytopathologic diagnosis of endometriosis in view of the possible danger caused by long-term pharmacologic therapy [18][19][20][21] and of the delay that is usually associated with this diagnosis. 8,22 …”

Endometriosis of Right Inguinal Subcutaneous Tissue

“…Hagiwara et al reported two cases of inguinal subcutaneous endometriosis attaching to the round ligament of the uterus. They mentioned there had been continuity between the lesion and right round ligament of the uterus, but no association with inguinal hernia [9,10].…”