Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of the Literature

Abstract

Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion. Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section

“…The main symptoms at presentation in our study included cyclic pain in 19 patients (63.3%) followed by feeling of mass lesion by 7 patients (23.3%), however 4 patients were asymptomatic and accidently discovered during a medical examination. Accidently discovered unusual findings are not uncommon and reported in many sites including the abdominal organs, skin and subcutaneous tissues [ 2 , 29 , [30] , [31] ]. Teng et al [ 26 ], found that all patients but two in their study had different severity of cyclic pain associated with menses saying that the diagnosis of AWE appears to be difficult if cyclical pain is not present.…”

“…When the lesion forms a circumscribed mass or blood-filled cystic lesion, hence designated as an endometrioma [ 1 ]. Abdominal wall endometrioma (AWE) is a rare aftermath of gynecologic operations mainly caesarean section (CS), myomectomy and abdominal hysterectomy causing intense pain and discomfort to the patient [ 2 ]. Malignant transformation of AWE is extremely rare but still a possibility; transformation to clear cell carcinoma and endometrioid carcinoma has been reported in several studies exhibiting aggressive prognoses [ [3] , [4] , [5] ].…”

“…Direct inoculation of the endometrial cells into abdominal wall fascia or subcutaneous tissue during surgery is considered the main cause of scar endometrioses which subsequently stimulated by estrogen and the produced estrogen by the endometriotic lesions has a substantial role in lesions' development and progression [ 8 ]. Fine needle aspiration cytology (FNAC) before excision runs the risk of needle track inoculation and implantation of the endometriotic lesion but histopathological examination of the resected mass is a good confirmatory tool [ 2 ]. Several treatment options for AWE have been suggested including surgical and non-surgical (pharmacological) treatment, but the definitive and the gold standard treatment is wide surgical excision (WSE) with 5–10 mm free margins to prevent recurrence [ 9 ].…”

“…Several treatment options for AWE have been suggested including surgical and non-surgical (pharmacological) treatment, but the definitive and the gold standard treatment is wide surgical excision (WSE) with 5–10 mm free margins to prevent recurrence [ 9 ]. Awareness of this entity within the abdominal wall can help the surgeons to make early and accurate diagnosis and deliver prompt surgical intervention [ 2 ].…”

Endometriosis Associated Striated Muscle Changes: Simulating Tumor

“…Endometriosis at the abdominal wall can be a diagnostic dilemma for both clinicians and pathologists. Endometriosis is a benign process; however, malignant transformation may occur [5,6]. Endometriosis in the skeletal muscle occasionally is associated with tissue destruction and repair.…”