Cesarean scar endometriosis: presentation of 198 cases and literature review

Abstract

BackgroundCesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). The aim of this study was to systematically identify the clinical features of CSE and recommend precautionary measures.MethodsA large, retrospective study was undertaken with CSE patients treated surgically at our hospital between January 2005 and December 2017.ResultsA total of 198 CSE patients were enrolled, with a mean age of 32.0 ± 4.0 years. The main complaint of the patients was abdominal mass (98.5%), followed by cyclic pain (86.9%). The latency period of CSE was 31.6 ± 23.9 months, and the duration between the onset of symptoms and this surgery was 28.3 ± 25.0 months. A majority (80.8%, n = 160) of the patients had undergone a Pfannenstiel incision, and a minority (19.2%, n = 38) a vertical midline incision. The latency period of CSE in the case of a Pfannenstiel incision was significantly shorter than that in the case of a vertical midline incision (24.0 vs 33.0 months, P = 0.006). A total of 187 (94.4%) patients had a single endometrioma, 11 (5.6%) patients had multiple endometriomas, and the 11 multiple-endometrioma patients had all undergone a Pfannenstiel incision. Lesions of endometrioma were common in corner sites, after either incision: 142/171 (83.0%) in Pfannenstiel incision scars and 32/38 (84.2%) in vertical incision scars.ConclusionsThe findings of this study indicate that the Pfannenstiel incision carries a higher risk of CSE than the vertical midline incision. Thorough cleaning at the conclusion of CS, particularly of both corner sites of the adipose layer and the fascia layer, is strongly recommended for CSE prevention. Further studies might provide additional recommendations.

The scar constituent Collagen I triggers coordinated collective migration and invasion in a 3D spheroid model of early endometriotic lesions

“…These observations agree with previous studies conducted on cancer cells suggesting that collagen content alone can increase the invasive cellular phenotype 37,38 . In conclusion, our results provide clear support for the clinical data suggesting that endometriosis commonly implants in scars 34 , including surgical scars such as that left behind by the Csection 33 . We next show that the collagen I defects caused by stromal cells arise due to matrix degradation via MMPs rather than due to cellular contraction and traction forces.…”

“…In particular, the invasive modes cells adopted using the 3-D spheroid model but not single cells on ECM could, for the first time, reproduce collective-migration phenotypes previously identified only through histological and clinical observations, further confirming the relevance of this model. Several clinical studies suggested endometriosis can only implant in damaged tissues 33,34,35 . To investigate this in vitro, we mimicked the intact tissue using the basement membrane mimic Matrigel and scar-tissue mimic collagen I.…”

Mixed endometrioid and clear cell carcinoma arising from laparoscopic trocar site endometriosis

“…Most of abdominal wall endometriosis has been reported to be associated with prior cesarean section, followed by uterine surgery . It is biologically possible because there is an opportunity for the inoculation of endometrial cells to the peritoneal cells from hysterotomy . Twenty‐one cases of laparoscopic port site endometriosis have been reported (Table ) .…”

“…Although the possibility of abdominal endometriosis unrelated to previous surgery cannot be completely ruled out, abdominal endometriosis other than umbilical or inguinal lesions is highly associated with previous surgery . In addition, tumor location corresponded to the trocar site.…”

An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section

“…The growth of functional endometrial tissues outside the uterine cavity is termed as endometriosis. It is a gynecological disorder depended on the sex hormone 1 .…”