Perineal Endometriosis in an Episiotomy scar: A Case Report and Review of Literature

Sharma, Neeraj; Khan, Dina Aisha; Jethani, Roma; Baruah, Surjit; Dey, Biswajit

doi:10.21767/2471-8165.1000066

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Endometriosis more commonly affects reproductive age group women (0.03-1.7%) whereas, 0.7%-44% prevalence rate was observed in general population. 1 Pelvis is the commonest site for endometriosis, especially ovaries, round ligaments and uterosacral ligaments. Extra pelvic sites such as bladder, gastrointestinal tract, lungs and skin also involved in some cases, especially after obstetric and gynaecological interventions.…”

Section: Introductionmentioning

confidence: 99%

An episiotomy scar site endometriosis: a rare case report and review of literature

Thirupathi

Rengaraj

2022

Int J Reprod Contracept Obstet Gynecol

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Endometriosis can be defined as the presence and growth of functioning endometrial tissue (glands and or stroma) outside the endometrium. Occasionally, surgical scars are the sites of endometriotic implantation particularly perineal scars (episiotomy). Perineal scar endometriosis is a very rare condition, its incidence rate was about 0.03-0.15%. Perineal scar endometriosis mainly affects young females at the episiotomy site following a previous vaginal delivery. A 29 years old patient presented with swelling at the site of episiotomy which was associated with pain during menstruation. On examination a palpable mass was revealed without induration at close proximity to episiotomy scar site during menstruation. MRI pelvis is the most commonly used imaging technique for the diagnosis of perineal endometriosis as well as to assess the deeper extent of the lesion. Mass excised and sent for histopathological examination. Wide local excision is the definitive treatment for surgical site endometriosis. Follow up is recommended for recurrence. The rare possibility of malignant transformation, can be excluded by histopathological examination of excised tissue.

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Section: Introductionmentioning

confidence: 99%

An episiotomy scar site endometriosis: a rare case report and review of literature

Thirupathi

Rengaraj

2022

Int J Reprod Contracept Obstet Gynecol

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“…Accordingly, some authors reported a 0.03% to 1.08% incidence of endometriosis in abdominal surgical scar in women undergoing pelvic surgery; nevertheless, malignancy transformation is very rare [5]. Perineal endometriosis is a rare condition and usually involves the episiotomy scar (occurring in only 0.00007% of births) [7].…”

Section: Introductionmentioning

confidence: 99%

Providing new insights into the endometriosisassociated cancer arising in episiotomy scars

et al. 2021

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Endometriosis-associated malignancy in an episiotomy scar is rare. The predictive factors are poorly understood as are the mechanisms and pathways associated with implantation and malignant transformation. In this study we describe the cases reported in the literature of malignancies arising in endometriosis foci of an episiotomy scar. We identified five cases described between 1990 and 2016. These cases represent recurrence of endometriotic lesions in an episiotomy scar after previous diagnosis of endometriosis, three to twenty-five months before. Histology revealed clear cell tumours in four cases and a serous papillary carcinoma. The approach encompassed surgical removal for diagnosis and as part of the therapeutic strategy. Adjuvant treatment was performed depending on classical prognostic factors. Mechanisms of endometriosis implantation in scars include the influence of oestrogens in the healing process and activation of COX-2, aromatase and matrix metalloproteinases. Nevertheless, for malignant transformation, other pathways seem to play a role, namely inflammation, immune response and oxidative stress, induced by iron deposits due to haemorrhage. Further studies are needed to allow the establishment of a predictive model for malignant transformation of endometriosis in episiotomy scars.

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Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

et al. 2021

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Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate.Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria.Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies).Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.

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Perineal Endometriosis in an Episiotomy scar: A Case Report and Review of Literature

Cited by 4 publications

References 13 publications

An episiotomy scar site endometriosis: a rare case report and review of literature

An episiotomy scar site endometriosis: a rare case report and review of literature

Providing new insights into the endometriosisassociated cancer arising in episiotomy scars

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

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