A National Survey of Umbilical Endometriosis in Japan

Abstract

To identify the clinical presentation, diagnostic evaluation, operative or medical management, and postoperative recurrence of umbilical endometriosis. Design: A retrospective national survey. Setting: Obstetrics and Gynecology and Plastic Surgery Departments at a teaching hospital in Japan. Patients: Patients with umbilical endometriosis or malignant transformation. Interventions: A national survey was conducted to identify and evaluate cases of umbilical endometriosis or malignant transformation documented between 2006 and 2016.Measurements and Main Results: The following were evaluated for each patient: age at diagnosis, body mass index, medical history, presence of extragenital endometriosis, surgical history, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence, and time to recurrence. Ninety-six patients were identified with pathologically diagnosed benign umbilical endometriosis. The patients frequently had swelling (86.5%), pain (81.3%), or bleeding (44.8%) in the umbilicus. Sensitivity was 87.1% for physical examination, 76.5% for transabdominal ultrasonography, 75.6% for computed tomography, and 81.8% for magnetic resonance imaging. The cumulative recurrence rate was 1.34% at 6 months, 6.35% at 12 months, and 6.35% at 60 months after surgery. Importantly, there was no recurrence after wide resection including of the peritoneum (0 of 37 cases). The efficacy of dienogest (an oral progestin), gonadotropinreleasing hormone agonists, and oral contraceptives was 91.7%, 81.8%, and 57.1%, respectively. Finally, 2 cases of malignant transformation were identified. Conclusion: There was a low recurrence rate following surgery, and hormonal treatment is an option, although the current findings suggest surgical therapy as the first choice of treatment for umbilical endometriosis.

Extra‐pelvic endometriosis: A review

“…[37][38][39][40][41][42][43] Among umbilical endometriosis, primary umbilical endometriosis is more frequent. 44,45 In a survey of 96 patients pathologically diagnosed with umbilical endometriosis, 66.7% had no history of prior surgery. 44 Similarly, in a case series review, 67.6% had no history of surgery.…”

The peculiar dermoscopic features of primary umbilical endometriosis

“…Editor Umbilical involvement is found in 0.5-1.2% of endometriosis and represents the most frequent location of spontaneous extra-pelvic endometriosis. 1 Umbilical endometriosis is most often primary and its aetiology is probably different from other forms of abdominal wall endometriosis, which are strongly related to a history of abdominopelvic surgery such as caesarean Figure 1 Physical examination. (a), Clinical image of the umbilicus containing three polypoid nodules; (b), dermoscopic aspect with immersion (DermLite DL4, magnification 109) showing a drainage hole on the top of each nodule (black star), one filled with an amorphous red material (white star).…”

“…section. 1 Herein, we describe the dermoscopic features of primary umbilical endometriomas with drainage openings.…”

“…Dear Editor Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most common immune-mediated encephalitis. 1 It is classically associated with underlying tumours, but the cases reported in patients with no history of cancer emphasize that the immune triggers remain unknown. 1 Causal association between central nervous system (CNS) immune-related disease and antitumour necrosis factor-alpha (TNFa) is plausible, as in multiple sclerosis (MS).…”

“…1 It is classically associated with underlying tumours, but the cases reported in patients with no history of cancer emphasize that the immune triggers remain unknown. 1 Causal association between central nervous system (CNS) immune-related disease and antitumour necrosis factor-alpha (TNFa) is plausible, as in multiple sclerosis (MS). 2 We present a case of severe anti-NMDAR encephalitis in a patient treated with adalimumab (Humira â , AbbVie, Chicago, IL, USA) for psoriasis.…”