Umbilical Endometriosis: A Rare Diagnosis in Plastic and Reconstructive Surgery

Abstract

Umbilical endometriosis infrequently presents to the plastic surgeon. As such, the diagnosis is difficult to make because it is often overlooked. The current report presents a 35-year-old nulligravid woman with a six-month history of a firm, cyclically swelling lesion in her umbilical region. None of the signs characteristic of pelvic endometriosis except dysmenorrhea and a one-year history of infertility were present. Biopsy of the lesion revealed umbilical endometriosis (grade IV), and laparoscopy uncovered extensive disease. Monopolar cautery with coagulating current umbilical excision and reconstruction with a purse-string suture was used. The results underscore the importance of a broad differential diagnosis for an umbilical lesion in a middle-age woman. They also highlight the importance of early recognition and appropriate surgical intervention to minimize morbidity and mortality associated with umbilical endometriosis.

Primary umbilical endometriosis: A rarity

“…The differential diagnosis of umbilical endometriotic lesions include pyogenic granuloma, umbilical polyps, melanocytic nevus, seborrhoeic keratosis, hemangioma, desmoids, and granular cell tumor. [ 6 7 ] Malignant lesions like melanoma, adenocarcinoma, squamous and basal cell carcinoma should be ruled out. Omphalitis, keloid, umbilical hernia, and foreign body granuloma are other differential diagnosis.…”

Umbilical Nodule with Cyclical Bleeding: A Case Report and Literature Review of Atypical Endometriosis

“…The symptoms most frequently associated with endometriosis are pelvic pain, dysmenorrhoea, dyspareunia, and subfertility/infertility [ 24 , 25 , 29 ]. Its pathogenesis is not completely understood and multiple theories have been proposed to explain it: implantation of endometrial cells through retrograde menstruation (endometrial tissue is transported during menstruations from the uterus through the fallopian tubes, therefore gaining access to and implanting on pelvic structures (the implantation or retrograde menstruation theory) [ 3 ]), haematogenous or lymphatic dissemination of endometrial cells (the dissemination theory), ectopic differentiation of pluripotent peritoneal progenitor cells to endometrial tissue (coelomic metaplasia theory) [ 3 , 24 , 25 , 30 ], production of substances to form endometriosis by sloughed endometrium (the induction theory), specific stimulation to a Müllerian origin cell nest producing endometriosis (the embryonic rest theory), and proliferation of ectopic endometrial cells produced by alterations in cell-mediated and humoral immunity (the cellular immunity theory) [ 3 ].…”

“…After laparoscopy, our patient was followed up with a standard gynaecological examination, the assessment of painful symptoms, and a TV-US scan that were performed at 1, 3, 6, and 12 months, and this will be repeated subsequently on a yearly basis. The differential diagnosis of an umbilical nodule includes inflammatory disorders (abscess, folliculitis, and omphalitis), other benign lesions (lipoma, haemangioma, inclusion cyst, urachal anomalies, and pyogenic granuloma), umbilical hernia, and malignant tumors (adenocarcinoma, sarcoma, melanoma, metastatic visceral carcinoma—Sister Mary Joseph nodule) [ 13 , 30 ].…”

An unusual case of asymptomatic spontaneous umbilical endometriosis treated with skin-sparing excision

“…Multiple hypotheses have been proposed for its aetiology, but its pathogenesis still remains unclear. Implantation of endometrial cells through retrograde menstruation, haematogenous or lymphatic dissemination of endometrial cells and the ectopic differentiation of pluripotent peritoneal progenitor cells to endometrial tissue (coelomic metaplasia) are amongst the most dominant theories of the pathogenesis of primary endometriosis [ 6 , 8 ]. Secondary endometriosis as a result of the iatrogenic implantation of endometrial cells during surgery, especially cell seeding during laparoscopic port cannulation, has also been hypothesized [ 1 , 7 ].…”