Endometriosis in Abdominal Scars: A Report of Three Cases Diagnosed by Fine-Needle Aspiration Biopsy

Abstract

Endometrioma in an operative scar is rare. The majority of patients have no prior history of endometriosis, and symptoms may mimic postoperative hernias. Fine-needle aspiration biopsy (FNAB) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses. We present the cytologic findings in three cases of abdominal wall endometriomas diagnosed by FNAB. The patients ranged from 31 to 51 years of age. None had a history of endometriosis, but all had prior abdominal operations (two abdominal hysterectomies for fibroids and one cesarean section). They presented 6 months to 7 years later with painful subcutaneous abdominal nodules in their scars ranging from 2 to 6 cm. FNAB was performed by a cytopathologist. The smears were cellular and comprised two distinct cell populations. An epithelial component consisted of flat sheets of polygonal cells with round to oval nuclei and scant cytoplasm. The second component consisted of clusters of fusiform stromal cells. Numerous hemosiderin-laden macrophages were noted in the background. Cytokeratin highlighted the epithelial clusters, and vimentin stained the stromal cells. Electron microscopy showed two epithelial cell types: one with cilia and abundant rough endoplasmic reticulum and the other with numerous microvilli and scattered mitochondria indicative of endometrial differentiation. FNAB provided a rapid and accurate preoperative diagnosis in each case.

Parietal endometriosis on cesarean scar: Study of a case

“…Palpation of the lesion should make it possible to assess its size and location in depth, the lesion frequently invading the abdominal muscles and their sheath. The main differential diagnoses of a mass associated with an abdominal scar are: hernias, granulomas on threads, abscesses, hematomas, neuromas, epidermoid cysts and finally, more rarely, malignant tumors (sarcoma, metastases of carcinomas) [1,21,22] . In the case of a typical picture, the diagnosis can be easy to evoke.…”

“…According to some authors [21] , an aspiration biopsy using a fine needle can make it possible to make the diagnosis or confirm it before considering any surgical treatment. Our experience leads us to prefer lumpectomy and single-stage treatment.…”

Endometrioma parietal. Rol del cirujano general. Reporte de casos y revisión de la literatura

“…Sin embargo, algunos autores desaconsejan su uso en pacientes con endometriosis pelviana por riesgo de metaplasia local. (28) Destacamos que en ninguna de nuestras pacientes existió la necesidad del uso de material protésico, dado que se realizó cierre parietal con hilo reabsorbible (PDS 1-0).…”