Abdominal Wall Endometriosis: A Case Report

Saliba, Christian; Jaafoury, Habib; Hajj, Mohamed El; Nicolas, G; Ahmad, Houssein Haidar

doi:10.7759/cureus.4061

Cited by 15 publications

(22 citation statements)

References 7 publications

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“…Clinical history is helpful in most of the cases. Abdominal wall endometriosis sometimes occurs after a cesarean section or pelvic surgery, and it has an incidence of 0.03%-1.5% in women with previous cesarean delivery [1]. Endometriosis should be considered when women present with intermittent or cyclic abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

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Endometriosis Associated Striated Muscle Changes: Simulating Tumor

Mirza

Abdulsattar

Cotelingam

2021

Case Reports in Pathology

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Endometriosis in the abdominal wall can be a diagnostic challenge, both clinically and pathologically. We are describing a case of abdominal wall endometriosis where regenerative muscle cells are florid. The cells are small and polygonal in shape, arranged in groups, and intersecting through differentiated skeletal muscle. Cells have pink cytoplasm and a centrally located nucleus. Immunohistochemistry demonstrates diffuse positivity with S100 and CD56, and they are negative with Ae1/Ae3, Pax8, inhibin, calretinin, and CD68. Cells are also focally positive with actin, vimentin, and myogenin. Electron microscopy reveals the presence of intracytoplasmic myofibrils. These groups of small cells are compatible with early to intermediately differentiated skeletal muscle cells as demonstrated by histomorphology, immunohistochemical pattern, and ultrastructure analysis. Muscle undergoes a regenerative process following injury. Endometriosis associated regenerative changes in muscle are very rare as documented in the English literature. The presence of florid regenerative muscle cells mimics a neoplastic process. In this report, we describe the histomorphological and immunohistochemical pattern of regenerative muscle groups and discuss differential diagnoses. We found electron microscopy to be an important diagnostic tool in this case.

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Section: Discussionmentioning

confidence: 99%

“…Most common locations are the ovary, broad ligament, fallopian tube, and nearby pelvic organs. Extrapelvic endometriosis is very rare, especially at the anterior abdominal wall location [1][2][3]. Patients with endometriosis at the abdominal wall usually present with a painful mass which is suspected as hernia or neoplasm [4].…”

Section: Introductionmentioning

confidence: 99%

Endometriosis Associated Striated Muscle Changes: Simulating Tumor

Mirza

Abdulsattar

Cotelingam

2021

Case Reports in Pathology

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“…It is important to have a thorough review of a patient's prior surgical history when assessing an anterior abdominal wall mass that may be an endometrioma. When evaluating an abdominal mass, although much less likely, the differential diagnosis should include desmoid tumors, hematomas, and soft tissue sarcomas [ 3 , 4 ]. In our case, the constellation of chronic pelvic pain, abdominal wall mass on imaging, and history of C-section is highly suggestive of the diagnosis of an abdominal wall endometrioma.…”

Section: Discussionmentioning

confidence: 99%

Post-Cesarean Section Abdominal Wall Endometrioma

Mao

Rana

Steffler

et al. 2020

Cureus

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A 30-year-old female with a history of multiple cesarean sections presents to the emergency department with several months of right lower quadrant abdominal pain only associated with her menstrual cycles. CT abdomen and pelvis with contrast was remarkable for an abdominal wall mass that likely represented an endometrioma, and she was subsequently discharged with pain medications and conservative treatment. However, three months later, she returned to the ED, because her pain was unbearable and refractory to medical management. Interventional radiology was consulted for percutaneous biopsy of the soft tissue mass located in her rectus abdominus muscle. Following the procedure, the patient was started on ORILISSA ® (elagolix), the first FDA-approved oral treatment for the management of severe pain associated with endometriosis. We highlight an interesting case of post-cesarean section abdominal wall endometrioma implantation and describe the patient's clinical course and disease management. The radiographic features of the mass are described and proposed mechanisms for the development of an abdominal wall endometrioma following a C-section is discussed.

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“…Endometriosis is defined as the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis was first described in 1860, and it affects 5%-10% of women population (1,2). It is most commonly located in the pelvis but in 12% of the published cases, it is also rarely observed in the gastrointestinal tract, lung, liver, bladder, kidneys, umbilicus, extremities, central nervous system and abdominal wall (1,3).…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal wall endometriosis (AWE), which was first reported by Meyer in 1903, is rarely observed, but it occurs most frequently following a cesarean or pelvic surgery. The patients consult the physician mostly with complaints of cyclic abdominal pain and a palpable mass in the abdomen (2,4,5). In the presence of the mass found, it can be mixed up with lipoma, abscess, hematoma, hernia, granuloma, desmoid tumor or sarcoma.…”

Section: Introductionmentioning

confidence: 99%

One of the rare reason of abdominal pain: abdominal wall endometriosis

Ergün

Öner²

2021

Turk J Surg

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Objective: Endometriosis is defined as the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. It is most commonly located in the pelvis but it is also rarely observed in the gastrointestinal tract, lung, liver, kidneys, central nervous system and abdominal wall. Abdominal wall endometriosis (AWE) commonly occurs following a caesarean section or pelvic surgery. The patients consult the physician mostly with complaints of cyclic abdominal pain and a palpable mass in the abdomen. The basic methods in diagnosing AWE are anamnesis and physical examination but ultrasound, computerized tomography, and sometimes magnetic resonance imaging of the abdomen are also used. Material and Methods: In our study, we retrospectively analyzed 9 patients who underwent surgery at Avcılar State Hospital General Surgery Service between January 2015 and December 2018 with a preliminary diagnosis of AWE and confirmation through pathology results. Results: Median age of the patients was 32 ± 4.66 and median body mass index (BMI) was 24.6 ± 1.15. Every patient except 1 had a history of cesarean section history. One patient was operated because of recurrence. Patients consulted the hospital with complaints of pain during menstruation and abdominal swelling. The start of the complaints was 4.1 years following C-section. Mostly ultrasound was used for imaging. For treatment, they all received en-bloc mass excision and their pathological diagnosis were compliant with endometriosis. Average surgery time was 40 minutes and average endometriosis lesion dimension was 3.4 cm. It was observed that the lesion extended to the anterior abdominal fascia in 6 of the patients, and 2 patients underwent fascia repair with propylene mesh because of the excessive defect size. No postoperative complication occured in any patient and no recurrence is observed. Conclusion: In patients with periodic abdominal pain and swelling on the abdominal wall, AWE could be suspected and early diagnosis can be realized by carefully taking medical history and following physical examination, and appropriate radiological examinations and necessary surgical intervention can be performed. The method of diagnosis and treatment is to remove the lesion through wide excision.

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Abdominal Wall Endometriosis: A Case Report

Cited by 15 publications

References 7 publications

Endometriosis Associated Striated Muscle Changes: Simulating Tumor

Endometriosis Associated Striated Muscle Changes: Simulating Tumor

Post-Cesarean Section Abdominal Wall Endometrioma

One of the rare reason of abdominal pain: abdominal wall endometriosis

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