Primary Cutaneous Endometriosis of Umbilicus

Abstract

Cutaneous endometriosis is defined by the presence of endometrial glands and/or stroma in skin and represents less than 1% of all ectopic endometrium. Cutaneous endometriosis is classified as primary and secondary. Primary cutaneous endometriosis appears without a prior surgical history and secondary cutaneous endometriosis mostly occurs at surgical scar tissue after abdominal operations. The most widely accepted pathogenesis of secondary endometriosis is the iatrogenic implantation of endometrial cells after surgery, such as laparoscopic procedures. However, the pathogenesis of primary endometriosis is still unknown. Umbilical endometriosis is composed only 0.4% to 4.0% of all endometriosis, however, umbilicus is the most common site of primary cutaneous endometriosis. A 38-year-old women presented with solitary 2.5×2.0-cm-sized purple to brown colored painful nodule on the umbilicus since 2 years ago. The patient had no history of surgical procedures. The skin lesion became swollen with spontaneous bleeding during menstruation. The skin lesion was diagnosed as a keloid at private hospital and has been treated with lesional injection of steroid for several times but there was no improvement. Imaging studies showed an enhancing umbilical mass without connection to internal organs. Biopsy specimen showed the several dilated glandular structures in dermis. They were surrounded by endometrial-type stroma and perivascular infiltration of lymphocytes. The patient was diagnosed as primary cutaneous endometriosis and skin lesion was removed by complete wide excision without recurrence. We report an interesting and rare case of primary umbilical endometriosis mistaken for a keloid and review the literatures.

Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature

“…Abdominal wall endometriosis is one of the major extrapelvic sites and usually is highly related to abdominal surgeries and obstetric and gynecological procedures [ 3 ] like a cesarean section, hysterectomy, amniocentesis, tubal ligation, appendectomies, umbilical hernioplasties, and laparoscopic trocar tracts [ 4 ]. Primary cutaneous endometriosis in the umbilicus was reported in a patient without any history of abdominal surgery [ 5 ].…”

An unusual case of primary umbilical endometriosis

“…Endometriosis is relatively common, affecting roughly 15% of childbearing women with the most common sites being the fallopian tubes, ovaries, and pelvic peritoneum 1 . Endometrial tissue in the skin, however, is quite rare and represents 1% of endometrial cases 2 . Cutaneous endometriosis typically occurs in women in their 30’s 1 .…”

Asymptomatic swellings in the umbilicus

“…Letztere tritt im Bereich von Narbengewebe nach Bauchoperationen auf. Als wahrscheinlichste Ursache gilt eine iatrogene Implantation von endometrialen Zellen [ 4,5 ] . Umbilikale endometriale Läsionen machen vermutlich 3,2 % bis 40,0 % der Fälle aus [ 6 ] .…”

“…Sie sind eine diagnostische Herausforderung, da die typischen klinischen oder anamnestischen Befunde fehlen. Pathogenetisch beruht die Erkrankung vermutlich auf einer vaskulären oder lymphatischen Migration von Endometriumgewebe über eine retrograde Menstruation, obwohl auch eine Metaplasie von residualen embryonalen Stammzellen in unserem Fall nicht ausgeschlossen werden kann [ 5 ] .…”

“…Die operative Entfernung der umbilikalen Endometrioseherde ist die Therapie der Wahl. In schweren Fällen können präoperativ Gonadotropin-Releasing-Hormon (GnRH)-Analoga indiziert sein, um die Größe der Läsionen, die Blutungen oder die Schmerzen zu verringern [ 4,5 ] . Eine maligne Transformation der umbilikalen Endometriose ist selten [ 15 ] .…”