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Biswas D, Dey P. All groin swellings are not lipoma. Cytopathology 2024; 35:167-169. [PMID: 37608537 DOI: 10.1111/cyt.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023]
Abstract
An interesting case of an abdominal wall swelling near an old operative scar showing epithelial and stromal cells. In this present paper, fine needle aspiration cytology of an inguinal swelling is discussed which may often create diagnostic confusion.
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Affiliation(s)
- Dipanwita Biswas
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
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Li SH, Sun HZ, Li WH, Wang SZ. Inguinal endometriosis: Ten case reports and review of literature. World J Clin Cases 2021; 9:11406-11418. [PMID: 35071572 PMCID: PMC8717526 DOI: 10.12998/wjcc.v9.i36.11406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To describe the characteristics, diagnosis and surgical treatment of inguinal endometriosis (IEM). CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019. Relevant features, symptoms, images, surgical treatment, hormonal therapy and follow-up were collected and discussed. A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side (9/11); five patients had symptoms related to the menstrual cycle, and only 3 patients were clearly diagnosed before surgery. Ultrasonography was of little assistance in confirming the diagnosis, but magnetic resonance imaging showed specific, high-intensity patterns. Anatomically, most of the IEM lesions were located in the extraperitoneal ligament (10/11); nine patients had inguinal hernias (IH), five had concurrent or prior pelvic endometriosis, and four had infertility. The clinical results from extensive resection were satisfactory. CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery. A right IH may contribute to the formation of right-sided IEM, and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.
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Affiliation(s)
- Shu-Hong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Heng-Zi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei-Hua Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Shu-Zhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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Mu B, Zhang Z, Liu C, Zhang K, Li S, Leng J, Li M. Long term follow-up of inguinal endometriosis. BMC WOMENS HEALTH 2021; 21:90. [PMID: 33653321 PMCID: PMC7927249 DOI: 10.1186/s12905-021-01235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.
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Affiliation(s)
- BoRan Mu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ZhiQiang Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Chongdong Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Kunning Zhang
- Department of Pathology, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ShuHong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - JinHua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - MengHui Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China.
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Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol 2020; 19:323-333. [PMID: 33071634 PMCID: PMC7542014 DOI: 10.1002/rmb2.12340] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology Doai Kinen Hospital Sumida-ku Japan.,Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Kaori Koga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
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Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 27:373-389. [DOI: 10.1016/j.jmig.2019.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 02/08/2023]
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Arakawa T, Hirata T, Koga K, Neriishi K, Fukuda S, Ma S, Sun H, Nagashima N, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Clinical aspects and management of inguinal endometriosis: A case series of 20 patients. J Obstet Gynaecol Res 2019; 45:2029-2036. [PMID: 31381248 DOI: 10.1111/jog.14059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/23/2019] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to describe the clinical presentation, diagnostic evaluation, and operative or medical management of inguinal endometriosis. METHODS In this study, we retrospectively reviewed 20 cases of inguinal endometriosis in our facility, particularly on the clinical characteristics, diagnosis, and surgical and medical treatment. RESULTS We retrospectively investigated the following items for each patient: age at diagnosis, surgical history, presence of extragenital endometriosis, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence and time to recurrence. We identified 20 cases of inguinal endometriosis in our facility. First, 75% of the patients had right inguinal endometriosis. Second, T1-weighted or fat-saturated T1-weighted images showed hyperintensity in the lesions in 17 patients (17/18 patients, 94.4%). Third, in 5 of 6 patients who underwent surgical therapy, we performed radical surgery to excise the inguinal lesion including the round ligament. One patient had disease relapse. Fourth, in 6 of 7 cases, dienogest effectively improved pain without significant adverse effects, but oral contraceptive was effective in 1 of 4 patients without significant adverse effects. CONCLUSION We retrospectively reviewed 20 patients with inguinal endometriosis in our facility. We have shown that magnetic resonance imaging can be a useful imaging modality to obtain a specific diagnosis of this disease. In addition, inguinal endometriosis can be managed with radical surgery to resect lesions including the round ligament and with hormonal treatment. In particular, dienogest ameliorated symptoms, which can be an option for patients who do not want surgery.
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Affiliation(s)
- Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Suke Ma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Wolfhagen N, Simons NE, de Jong KH, van Kesteren PJM, Simons MP. Inguinal endometriosis, a rare entity of which surgeons should be aware: clinical aspects and long-term follow-up of nine cases. Hernia 2018; 22:881-886. [PMID: 30078093 DOI: 10.1007/s10029-018-1797-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inguinal endometriosis is a rare disease and often misdiagnosed for other, more common groin pathology. We present nine cases of women with inguinal endometriosis with long-term follow-up. METHODS In this retrospective case series, the Dutch PALGA system was searched for all patients diagnosed with extrapelvic endometriosis located in the groin in the OLVG hospital, Amsterdam, between 2000 and 2016. Relevant information regarding pre- and postoperative characteristics and symptoms was collected. Follow-up consisted of a telephone call from the attending surgeon. RESULTS None of the patients had a history of pelvic endometriosis. Typically, they presented with a right-sided swelling in the groin. Preoperative ultrasound and MRI were in most cases inconclusive. In one of two patients fna indicated endometriosis. In only three patients the surgeon considered the diagnosis endometriosis preoperatively. Surgical removal was effective with no reported complications. A coexisting hernia sac was resected in four cases, and there was a suspicion of a persistent processus vaginalis (canal of Nuck) in three, suggesting that a persistent processus vaginalis is possibly an important key to the pathogenesis. In none of the cases there was an indication for mesh implantation. One patient was later diagnosed with pelvic endometriosis. CONCLUSION Follow-up by a gynecologist is advised to check for intra-abdominal disease and inform patients on fertility perspective. Surgeons should be aware of the possibility of inguinal endometriosis in fertile women with a lump in the groin.
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Affiliation(s)
- N Wolfhagen
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - N E Simons
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - K H de Jong
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P J M van Kesteren
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
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Ding Y, Gibbs J, Xiong G, Guo S, Raj S, Bui MM. Endometriosis Mimicking Soft-Tissue Neoplasms: A Potential Diagnostic Pitfall. Cancer Control 2017; 24:83-88. [DOI: 10.1177/107327481702400114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Yi Ding
- Departments of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julie Gibbs
- Beijing Jishuitan Hospital, Fourth Medical College of Peking University, China, Department of Pathology and Cell Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ge Xiong
- Hand Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Shigong Guo
- University of South Florida Morsani College of Medicine, Tampa, Florida, Department of Trauma & Orthopaedic Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Shailaja Raj
- St Mary's Hospital, London, United Kingdom, and the Departments of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Marilyn M. Bui
- St Mary's Hospital, London, United Kingdom, and the Departments of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Inguinal Endometriosis – A Series of Five Cases and Literature Review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Endometriosis is a benign gynecological pathology defined as the presence of ectopic endometrial tissue which grows in response to hormonal stimulus. It affects women of reproductive age, with a prevalence of 10%-20%. Although it appears mainly in the pelvic organs, we can find lesions in extrapelvic locations. Inguinal endometriosis is a very rare event. A history of painful inguinal mass, with exacerbation related to the menstrual cycle is the hallmark of diagnosis. However, typical symptoms may not be present or can mimic other inguinal pathology, posing a diagnostic challenge. In this article we present five cases of inguinal endometriosis referred to our institution along with a brief review of literature. Case Report We describe five clinical cases of women with inguinal endometriosis. Four of these cases were initially referred to general surgery and two of them had a primary diagnosis of inguinal hernia. Three patients were submitted to biopsy, which established the diagnosis of endometriosis prior to surgery in all. Surgical excision of the lesion was performed in all but one patient who refused treatment, and there were no serious complications or recurrences. Discussion Inguinal endometriosis is a rare condition. To diagnose this situation, physicians need to be aware of this pathology and include it in the differential diagnosis when facing a child-bearing age woman with complains of painful inguinal mass. Although the definitive diagnosis is histological, ultrasound or MRI may be helpful to establish a presumptive diagnosis. Surgical excision is the treatment of choice and is, in general, definitive.
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