Clear cell adenocarcinoma arising from umbilical endometriosis

Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review

Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.

A surgical case report on primary umbilical endometriosis (Villar's nodule)

Endometriosis is a disease characterized by the implantation of endometrial-like tissue outside the uterine cavity. Common symptoms include cyclical pain, dysmenorrhea, dyspareunia, and infertility. Although endometriosis can spread to various extrauterine locations including the ovaries, fallopian tubes, and peritoneal surfaces, umbilical endometriosis is a rare manifestation of the disease. We report an intriguing clinical case of primary umbilical endometriosis in a 36-year-old female patient admitted to our department due to the notable manifestation of a painful swelling at the umbilicus, accompanied by cyclic episodes of bleeding. Subsequent investigations, incorporating ultrasound and computed tomography, indicated the presence of umbilical endometriosis, a finding that was subsequently confirmed by pathological examination of a mass biopsy. Surgical resection of the umbilical mass was performed, and histopathological analysis definitively confirmed the diagnosis of endometriosis. This case report aims to discuss in depth the diagnosis and management of umbilical endometriosis.

Primary versus secondary cutaneous endometriosis: Literature review and case study

Cutaneous endometriosis, characterized by the presence of endometrium or endometrial-like tissue outside of the uterine cavity, is an uncommon and chronic disease. Depending on a patient's history, cutaneous endometriosis is classified as either primary cutaneous endometriosis (PCE) or secondary cutaneous endometriosis (SCE). We report a case of SCE presenting with the classic triad of previous caesarean section, subcutaneous nodules at the site of the scar, and pain associated with menstruation. Considering histopathology as the standard, we confirmed a diagnosis of cutaneous endometriosis by ultrasound and histopathology. Furthermore, we compared and analyzed the clinical characteristics of PCE and SCE, the study included 20 and 14 patients with cutaneous endometriosis diagnosed with PCE and SCE respectively. In the PCE group, the mean age of patients at the onset was 33.7 years, while it was 40.6 years in the SCE group. The mean disease-duration time of PCE was shorter than that of SCE (1.3 vs. 2.8 years, P > 0.05). The most common clinical presentation of PCE and SCE was a nodule (90% vs. 86%). The PCE was mainly bleeding with pain (45%), whereas the SCE of only pain and bleeding with pain accounted for the same proportion (45%). The most common sites of PCE and SCE were in the umbilical region (90% vs. 57%, P < 0.05). In our study, some statistically significant difference was found between different types of CE and it may contribute to improve clinicians' understanding of the disease, and perform early diagnosis and treatment.

Clinical Features and Management of Umbilical Endometriosis: A 30 Years' Monocentric Retrospective Study

INTRODUCTION

Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5-1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE.

MATERIAL AND METHODS

We retrospectively reviewed all cases of women diagnosed with UE in the period 1990-2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions.

RESULTS

A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received.

CONCLUSIONS

The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.

A woman with recurrent umbilical bleeding: a case report

Background

Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired pathology such as umbilical hernias. The umbilicus can be a site of primary or metastatic malignancy or endometriosis.

Case presentation

A 40-year-old white American woman came to the clinic with a 2-day history of spontaneous umbilical bleeding. She reported periumbilical pain associated with nausea and emesis. There were no visible skin abnormalities, but deep palpation of the abdomen produced a thin, watery, serosanguineous fluid from the umbilicus. She experienced a similar episode of umbilical bleeding 5 years prior without clear cause. Laboratory workup was notable for mildly elevated C-reactive protein . Computed tomography imaging revealed a fat-containing umbilical hernia with fat necrosis, necessitating complete surgical resection of the umbilicus.

Conclusions

Umbilical hernia with fat necrosis is a rare condition that should be considered in adults with umbilical discharge. Additional diagnostic considerations in adults with spontaneous umbilical bleeding/discharge include embryonal remnants, omphalitis, and metastasis. If the cause is not readily apparent on physical exam, imaging with computed tomography should be considered to assess for hernia and embryonal anomalies.

Primary umbilical endometriosis presenting with umbilical bleeding: A case report

Endometriosis is a condition in which endometrial tissue implants outside the uterine cavity, which can cause cyclic pain, dysmenorrhea, dyspareunia, and infertility. Endometriosis implants are typically seen on pelvic peritoneal surfaces and extra-pelvic disease is uncommon. We present an interesting case of primary umbilical endometriosis in a patient who presented with umbilical bleeding with a history of pelvic inflammatory disease complicated by bilateral tubo-ovarian abscesses. She was found to have an umbilical mass, which was resected, and the pathology was consistent with endometriosis. The objective of this case report is to detail the case and discuss diagnosis and management of umbilical endometriosis. It is important to recognize that umbilical endometriosis can occur in patients with no surgical history.

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Primary umbilical endometriosis occurs spontaneously.

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Diagnosis of umbilical endometriosis is clinical, but pathology confirms it.

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Signs of umbilical endometriosis include cyclic umbilical bleeding/pain and swelling.

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Surgical management is the primary treatment of choice.

Coexistence of cutaneous endometriosis and ovarian endometrioma: a case report

Background

Umbilical endometriosis is a rare entity accounting for 0.5–4% of cases with endometriosis.

Case presentation

Here we report a rare case of umbilical endometriosis with concurrent ovarian endometriomas in a 37-year old primiparous Iranian woman.

Conclusion

This interesting coexistence reflects the importance of thorough gynecological assessment in patients with cutaneous endometriosis to enable appropriate management.

Incidence of extraovarian clear cell cancers in women with surgically diagnosed endometriosis: A cohort study

BACKGROUND

Endometriosis is associated with increased risk of clear cell ovarian cancer and has even suggested being an etiological factor for this cancer. Association between endometriosis and extraovarian clear cell cancers is unclear. This study aimed to assess the association between surgically diagnosed endometriosis and risk of extraovarian clear cell cancers according to the type of endometriosis (i.e., ovarian, peritoneal, and other endometriosis) and the site of clear cell cancer.

METHODS

In this register-based historic cohort study we identified all women with surgically diagnosed endometriosis from the Finnish Hospital Discharge Registry 1987-2012. Data on extraovarian clear cell cancers of these women were obtained from the Finnish Cancer Registry. The follow-up started January 1st, 2007 or at endometriosis diagnosis (if later), and ended at emigration, death or on the December 31st, 2014. Standardized incidence ratios were calculated for each site of clear cell carcinoma (intestine, kidney, urinary tract, gynecological organs other than ovary), using the Finnish female population as reference.

RESULTS

The endometriosis cohort consisted of 48,996 women, including 22,745 women with ovarian and 19,809 women with peritoneal endometriosis. Altogether 23 extraovarian clear cell cancers were observed during 367,386 person-years of follow-up. The risk of extraovarian clear cell cancer was not increased among all women with surgically diagnosed endometriosis (standardized incidence ratio 0.89, 95% confidence interval 0.56-1.33) nor in different types of endometriosis. The incidence of clear cell cancer in any specific site was not increased either.

CONCLUSIONS

The risk of extraovarian clear cell cancers in women with surgically diagnosed endometriosis is similar to that in the general population in Finland.

Umbilical endometriosis: a case series

BACKGROUND

Endometriosis is the presence of endometrial tissue outside the uterine cavity. The lesions are typically found in the pelvic cavity but can occur in other extrapelvic areas. Umbilical endometriosis, also known as Villar's node, is a rare disease comprising 0.5-1% of all extrapelvic disease. It commonly presents with cyclical pain and bleeding from an umbilical nodule.

CASE SERIES

We present a retrospective case series of five African patients with umbilical endometriosis diagnosed and treated between July 2015 and February 2019 at a tertiary health facility. The patients were aged between 31 and 47 years, and all presented with an umbilical swelling and pain. They had lesions with diameters ranging from 1.6 cm to 4 cm. The duration of symptoms ranged between 3 and 60 months. Their diagnoses were made on the basis of clinical presentation followed by surgical excision. In all the cases, diagnosis was confirmed by histopathology with no malignancy detected.

CONCLUSION

Umbilical endometriosis is a rare condition that should be considered as a differential diagnosis in women with umbilical lesions. Diagnosis is mostly clinical; most patients present with umbilical swelling, cyclical pain, and bleeding or discharge. Imaging has a limited role. Surgical excision is the treatment of choice with low risk of malignancy or recurrence.

Extra-pelvic endometriosis: A review

Background

Extra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE).

Methods

The authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis.

Main findings

Abdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP.

Conclusion

Evidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.

Primary Umbilical Endometriosis in an Adolescent Girl: Unsuspected Pathology

Endometriosis affects 7 to 10% of women of reproductive age. Primary umbilical endometriosis (PUE) is even rarer with unclear pathogenesis. We report a case of PUE possibly the youngest patient reported in the literature.

A 16-year-old girl of African origin presented with painful umbilical lump for 2 to 3 months duration with background history of precocious puberty, cyclical vomiting, and menorrhagia. Clinical examination showed dark-colored, tender, irreducible umbilical lump. A provisional diagnosis of incarcerated umbilical hernia was made. Abdominal X-ray showed no features of intestinal obstruction. Ultrasound scan of the abdomen showed lump containing heterogeneous echogenic material measuring 2.0 × 1.5cm within the umbilicus with no visible bowel loops or peristalsis. This was reported as consistent with an umbilical hernia with narrow neck possibly containing mesentery or intra-abdominal fat. The patient underwent urgent exploration of umbilicus under general anesthetic. At operation, a dark-colored, firm mass was excised and sent for histology. The underlying fascia and peritoneum were repaired.

Histological examination confirmed the excised tissue was endometriosis. Follow-up continues in the endometriosis clinic.

Umbilical endometriosis should be considered in differential diagnoses of painful umbilical lesion in adolescent girls and women of reproductive age. Complete excision and histology are highly recommended for obtaining a definitive diagnosis, to exclude malignancy and to prevent recurrence.

Primary Umbilical Endometriosis: Case Report with Literature Review

Villars nodule, also known as umbilical endometriosis, is a rare umbilical disorder, usually affecting women of child bearing age. Endometriosis is a functional endometrial tissue found outside the uterine cavity, which affects the umbilicus in 0.5-1% of all extragenital sites. Correct diagnosis is challenging and commonly missed, but once a diagnosis has been made, the recommended management is surgical excision. We are reporting a case of primary umbilical endometriosis in a 31-year-old nulliparous patient, who presented with an umbilical mass of one year duration. Histopathology confirmed the diagnosis of endometriosis and the mass was widely excised.

Umbilical Nodule with Cyclical Bleeding: A Case Report and Literature Review of Atypical Endometriosis

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. It affects 3 to 10 percent of women of reproductive age. Umbilical endometriosis is rare, with an estimated incidence of 0.5–1.0% among all cases of endometriosis, and is usually secondary to prior laparoscopic surgery involving the umbilicus. In this report, we described a case of umbilical endometriosis treated with surgical resection and highlight the great importance of medical history compared to complementary diagnostic tests that can be sometimes inconclusive.

Primary Umbilical Endometriosis: Unusual and Rare Clinical Presentation

Primary umbilical endometriosis is a rare disorder and is defined as the presence of ectopic endometrial tissue within the umbilicus. A patient with painful mass in the umbilicus during menstrual period is studied in this paper. The possibility of subcutaneous endometriosis should be considered when an umbilical mass is detected despite the absence of previous surgery. In this case, urachal cancer, urachal remnant, umbilical endometriosis, and its malignant transformation were among the diseases considered in the differential diagnosis. Complete excision and histology are necessary to obtain a definitive diagnosis and optimal treatment for umbilical subcutaneous endometriosis.

Primary Endometriosis of Umbilical Scar: Case Report and Review of Literature

We report a case of umbilical endometriosis and review the literature about the finding. The patient was a 39-year-old woman who presented with 6 months of umbilical bleeding and pain during the first day of her period. A soft tissue ultrasound scan showed 2 superficial solid masses within the periumbilical subcutaneous adipose tissue, suggestive for ectopic endometriosis localization. We decided to remove the umbilical nodules, excising 1 cm of the surrounding tissue. Reports in the literature indicate cases of umbilical endometriosis in about 0.5%-1% of women with endometriosis.

Primary umbilical endometriosis. Case report and discussion on management options

INTRODUCTION

We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition.

PRESENTATION OF CASE

A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months.

DISCUSSION

UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.

CONCLUSION

Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

Chronic Umbilical Discharge: An unusual presentation of endometriosis

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-year-old type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality. The umbilicus was excised and histology confirmed endometriosis. Surgical excision provides a definitive diagnosis and curative treatment for isolated endometriosis.