Suburethral Endometriosis as Clinical Finding of Extensive Disease

Abstract

Objective: Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. In an extensive literature review only 4 cases of suburethral endometriosis were identified. Our objective is to present a case of primary vaginal suburethral endometriosis in a 31-year old patient who underwent laparoscopic evaluation and to perform a literature review on this topic. Methods and Procedures: Case report presentation based on information extracted from patient database. A review of literature with a Medline search using key words urethral endometriosis, suburethral endometriosis, or urethral diverticulum was undertaken. Results: This case report describes a case of a 31-year old female patient referred for severe pelvic pain, worsening during menstruation. On physical examination a 2 cm suburethral endometriotic lesion was found as the initial presentation. Her examination was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. The review of literature revealed only 4 cases where suburethral endometriosis was previously identified. Conclusion: Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision, and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions.

Mesonephric Cyst Endometrioma: Surgical Management of an Atypical Site Endometriosis

“…A nonendometriotic origin concept, also termed as celomic metaplasia includes the transformation of peritoneal tissue to ectopic endometrial tissue via metaplasia. 5 Extragenital malignant mixed mesodermal tumors (MMMTs) are extremely rare and have been associated with endometriosis, Wolfian duct remnants, and ovarian cyst adenocarcinoma. Twelve cases have been reported in the literature.…”

“… 6 In advanced stage of endometriosis and deep infiltrating endometriosis cases surgical excision is the ideal therapeutic option for definitive treatment compared to medical management, and comprehensive disease mapping before surgery is necessary to avoid residual disease. 5 , 6 …”

“…The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) are present only in 50% of patients, but imaging is fundamental for the evaluation of exact location and size of the lesions. [3][4][5] Transvaginal ultrasound is the most cost-effective imaging modality and should be performed first. [1][2][3] Magnetic resonance imaging offers an added advantage compared to other imaging modalities due to high soft tissue contrast and multiplanar images.…”

“…The typical cyclical symptoms are present only in 50% patients. [1][2][3][4][5] Its pathogenesis is widely argued, and its inconsistent morphology represent a continuity of individual presentations and progressions. With increasing distance from uterus these lesions appear asynchronous with tendency to lose hormonal receptors.…”