Hepatic pedicle endometriosis: Case report and review of the literature

Abstract

The localization of endometriotic disease in the hepatic pedicle has never been reported to date. We report the first case of a 67‐year‐old postmenopausal patient having presented an endometriotic lesion in the hepatic pedicle. A surgical biopsy was needed to confirm the diagnosis after a first radiologic biopsy that concluded the presence of a mucinous cystic tumor with low‐grade dysplasia. Medical treatment with aromatase inhibitors was carried out because of the inextirpable nature of the lesion. The diagnosis and therapeutic management of this rarely occurring lesion of atypical localization in a postmenopausal patient is presented here. A review of the literature on this localization could have led to a damaging surgical treatment due to the different diagnoses suggested. Management of endometriosis relies on a multidisciplinary approach that each practitioner must know how to broach with patients of all ages.

Estrogen Receptors and Endometriosis

“…These combinations reduced visible lesions and pelvic pain refractory to other available medical and conservative surgical treatments [83,84]. In postmenopausal situations and in particular in cases of lesions that cannot be resected surgically, aromatase inhibitors are the treatment of choice [22,85].…”

“…A second theory about the mechanism of the onset of endometriosis suggests that the epithelial peritoneal lining might transform into endometrial tissue under the influence of stimuli: this is the theory of coelomic metaplasia [20,21]. Another theory, of the benign lymphatic or haematogenous metastases, proposes an extraperitoneal dissemination of endometrial tissue via the lymphatic ducts and implies that the ectopic endometrial cells have migratory abilities [22]. Several risk factors including endocrine, genetic, biochemical, environmental, and immunological factors are effective in the initiation and progression of the disease [6,23].…”

Rare extragenital endometriosis: pathogenesis and therapy

“…A hormonal treatment of HE has been proposed, with progestogens, danazol and GnRH agonists [132], but even if the symptoms are reduced, the side effects and long-term risks of these treatments remain. Eychenne et al [133] reported medical treatment with aromatase inhibitors in postmenopausal patients as the lesions were not surgically attackable. Prodromidou et al [123] analyzed data regarding 31 patients with HE following operation.…”

“…The most convenient therapy is surgical, and the type of surgery depends on the extent of the lesion and its localization (Table 4, Ref. [133,[136][137][138][139][140][141][142][143][144][145][146][147][148][149]).…”