Abdominal Wall Endometriosis: Myofibroblasts as a Possible Evidence of Metaplasia: A Case Report

Abstract

In this study, we report about a patient with extra-uterine endometriosis (EM) in the abdominal wall muscle with evident metaplasia based on the abundant alpha smooth muscle actin (ASMA)-expressing myofibroblasts. Laparotomy excision of the abdominal wall EM was done following ultrasonographic evidence of a hypodense swelling in the right rectus abdominis, which was confirmed by MRI. Immunohistochemistry staining for ASMA and collagen I was done, with the results confirming that endometriotic stromal cells expressed both. Anterior abdominal wall endometriosis was suspected because of the patient's history of recurrent EM combined with the cyclic nature of symptoms. MRI is useful in determining the extent of the disease. In case of persisting symptoms even under hormonal treatment, surgical excision is mandatory. The expression of both ASMA and collagen I in and around EM lesions supports the notion of the metaplastic process in the course of disease development.

Rectus Abdominis Endometriosis Following Cesarean Section: A Case Report

“…In certain instances, the diagnosis is established postoperatively following an excisional biopsy [ 18 ]. Histopathological examination typically shows the presence of endometrial glands and stroma embedded in the skeletal muscle fibers of the rectus abdominis muscle [ 10 , 14 ]. The glands are encased by columnar epithelial cells, while the stroma consists of small, spindle-shaped cells with minimal cytoplasm [ 9 ].…”

“…Notably, abdominal wall endometriosis has been linked to iatrogenic dissemination following surgical procedures in the abdomen [7]. Furthermore, the potential for lymphatic and vascular spread has been considered in the pathogenesis of extrapelvic endometriosis [7,10,[12][13][14].…”

“…The most common symptoms include abdominal pain that intensifies during menstruation, dysmenorrhea, irregular menses, dyspareunia, or infertility [2,8]. Noncyclical abdominal pain can also be a symptom of this condition in one-third of patients [14]. A palpable nodule may be detected during a clinical examination, typically located adjacent to a surgical scar [16].…”

Women with Endometriosis—Who Is at Risk for Complications Associated with Pregnancy and Childbirth? A Retrospective Case–Control Study

“…Activated stem cells can also leave their niche and migrate into the myometrium or through the fallopian tubes into the pelvic cavity. Endometrial tissue can thus disperse and form new endometriosis lesions [15,16].…”

When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

“…Endometriosis is a benign chronic inflammatory disease affecting millions of women worldwide during their reproductive years [ 1 , 2 ]. The pathogenesis is still under debate, however, most likely, stem cell such as cells from retrograde menstruation adhere to the peritoneal surface and develop into peritoneal endometriotic lesions [ 3 , 4 ]. Apart from the establishment of such ectopic lesions, numerous and brisk immune cell infiltrates were found within the microenvironment of these lesions, indicating acute immunological reactions [ 5 , 6 ].…”