Fine‐needle aspiration cytology of scar endometriosis: Study of seven cases and literature review

Abstract

Endometriosis is defined as the presence of endometrial-like glands and stroma outside the uterine endometrial lining. Endometrial tissue has also been identified in numerous surgical or procedure scars, including cesarean section and laparoscopic trocar tract. A prospective study was conducted at Maternidade-Escola Assis Chateaubriand, Faculty of Medicine, Federal University of Ceara, Brazil in seven patients with abdominal wall mass pathologically proven as scar endometriosis from January 2004 to December 2008. All cases were submitted to fine-needle aspiration cytology (FNAC). Age ranged from 21 to 42 years old (mean: 30) with parity ranging from 0 to 3 (mean: 1.4). The preceding history of pelvic procedures was miomectomy (1 of 7), cesarean section (3 of 7), and diagnostic laparoscopy (3 of 7). The complaints occurred about 18 months after the surgical proceeding. The FNAC findings were endometrial-like epithelial cells (6 of 7) and stromal cells (6 of 7); decidualization occurred in 2 of 7 cases. Hemosiderin-laden macrophages were present in all cases. FNAC is a fast and accurate method to make the diagnosis before the surgery, avoiding errors in the approach of the abdominal wall endometriosis' scars.

Case Report of Recurrent Abdominal Wall Endometrioma at the Same Location after Nine Years of Its First Excision

“…Some authors suggest that, US guided biopsy is not recommended when endometrioma is suspected due to the potential risk of cellular spread during the invasive procedure, and consequently, the risk of recurrence related to the technique [11,12].…”

Primary Umbilical Endometriosis: Report of a Rare Case

“…Differential diagnoses also include primary cancer of umbilicus (basal cell & squamous cell carcinoma), melanoma & paget's disease 4 . The cytological features of cutaneous & sub cutaneous endometriosis are related to cyclic hormonal changes 2,7 . The cytological smears generally shows cellular with epithelial & stromal fragments admixed with hemorrhage & hemosiderin laden macrophages 7 .…”

“…However umbilical endometriosis has been reported in more than hundred cases. The majority of the reported cases occurred in obstetrical & gynecologically induced abdominal or pelvic scars including hysterectomy, episiotomy, caeserian section & laparoscopy 7 . Few cases of primary umbilical endometriosis have been reported 2,3,7,8 .…”

Cytodiagnosis of scar endometriosis

“…[3] History of catamenial exacerbation, i.e., increase in pain and tenderness in a lump during menstruation and location of a firm, tender swelling near a scar either of C section, laparotomy, hysterectomy or episiotomy point toward the diagnosis of scar endometriosis. [4] On radiological examination, the swelling is in the subcutaneous plane with no intraperitoneal communication.…”

“…In the secretory phase, glandular cells show an increase in cell size and microvacuolation while stromal cells reveal abundant cytoplasm. [4]…”