5-Year data analysis of patients following abdominal wall endometrioma surgery

Surgical and Percutaneous Image-Guided Therapies of Abdominal Wall Endometriosis: A Systematic Review of Current Evidence

OBJECTIVE

Despite various surgical and nonsurgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making.

DATA SOURCES

We performed a systematic literature review of PubMed, Embase, and Cochrane Library databases from 1947 until December 2023.

METHODS OF STUDY SELECTION

A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation, and microwave ablation. This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR), and adverse events (AE) were recorded.

TABULATION, INTEGRATION, AND RESULTS

This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2674 patients are included: 2219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 radiofrequency ablation, 9 microwave ablation). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9-97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7-99.9) and 76.1% (95% CI, 61.8-90.4); and cryoablation of 85.7% (95% CI, 66.0-99.9) and 79.2% (95% CI, 67.4-91.03). Minor AE was reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7% (9/103) after cryoablation. Severe AE was reported in 25 patients in the surgery group and 1 in the percutaneous group.

CONCLUSION

The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis.

Surgery of abdominal wall endometriosis associated with clear-cell carcinoma: Case report and review

Abdominal wall is a rare location for endometriosis, with a reported incidence of parietal endometriosis of approximately 0.03 to 0.4%. It most often occurs in the aftermath of a caesarean section and is associated with pelvic endometriosis in only 5 to 15% of cases. Rare cases of malignant transformation have been described, mainly in the form of clear-cell tumours. We report the case of a 52-year-old patient with a history of endometriosis who presented with a retractile parietal mass at the level of her caesarean scar. Histological analysis confirmed a clear-cell adenocarcinoma (CCC). Few cases of endometriosis - associated CCC are described in the literature. A review of the literature suggests radical surgical treatment combined with adjuvant radio-chemotherapy. However, the prognosis is poor. The aim of this case report is to suggest the diagnosis of malignant transformation in the presence of a rapidly evolving parietal mass in the context of endometriosis and a history of caesarean section.

The Benign Side of the Abdominal Wall: A Pictorial Review of Non-Neoplastic Diseases

The abdominal wall is the location of a wide spectrum of pathological conditions, from benign to malignant ones. Imaging is often recommended for the evaluation of known palpable abdominal masses. However, abdominal wall pathologies are often incidentally discovered and represent a clinical and diagnostic challenge. Knowledge of the possible etiologies and complications, combined with clinical history and laboratory findings, is crucial for the correct management of these conditions. Specific imaging clues can help the radiologist narrow the differential diagnosis and distinguish between malignant and benign processes. In this pictorial review, we will focus on the non-neoplastic benign masses and processes that can be encountered on the abdominal wall on cross-sectional imaging, with a particular focus on their management. Distinctive sonographic imaging clues, compared with computed tomography (CT) and magnetic resonance (MR) findings will be highlighted, together with clinical and practical tips for reaching the diagnosis and guiding patient management, to provide a complete diagnostic guide for the radiologist.

Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section

BACKGROUND

Over the past few decades, the rate of Cesarean Section (CS) delivery has been rising rapidly and the prevalence of CS-associated complications including Abdominal Wall Endometriomas (AWE) increases with each additional operation. The aim of this study was to evaluate the clinical characteristics, histopathological diagnostic role and surgical management of post-CS AWE through a retrospective case review.

METHODS

We calculated the incidence of AWE and reviewed all the patients underwent surgical removal of Post-CS AWE during the period of 2012-2018 who were diagnosed, treated and followed up for 2-8 years at our tertiary hospital.

RESULTS

Thirty women with AWE were included. The main symptom in 2/3 of cases was cyclic pain and 4 cases (13.3%) had no symptoms. The mean interval between prior CS and appearance of symptoms was 55.2 months and the mean size of the excised mass was 42 mm. Free surgical margin was less than 9 mm in 9 patients (30%) but no recurrence was recorded among all the studied patients. Pre-operative FNAC diagnosis was performed for only 3 patients (10%) which helped in excluding other potential pathologies. The clinical-pathological agreement value for detection of the nature of the abdominal wall mass was 93.4%.

CONCLUSIONS

Patients with suspected AWE should undergo preoperative cytological biopsy to exclude alternative diagnosis. Wide surgical excision with margin of less than 1 cm could be accepted especially in case of weak abdominal wall. More studies on the post-CS complications; risks, prevention, early detection and proper management should be encouraged.

Abdominal wall endometriosis: experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense

OBJECTIVE

to study the characteristics of women undergoing abdominal surgery with suspected abdominal wall endometriosis or abdominal wall tumor, and to assess the association with age, race and previous cesarean delivery.

METHOD

retrospective and analytical study carried out from January 2000 to December 2019, at the General Surgery Service of Hospital Universitário Antônio Pedro (HUAP) at Universidade Federal Fluminense (UFF). Medical records of 100 patients with abdominal wall endometriosis and other types of abdominal wall tumors were analyzed. Age, color, previous history of cesarean section or abdominal surgery and histopathological data were verified. The patients were classified as young adults (aged between 18 and 28 years and 11 months) and adults. The SPSS program was used for data analysis, Fisher's test with a significance level of 0.05.

RESULTS

abdominal wall endometriosis with histopathological confirmation was found in 22%, the mean age was 52.28 ± 18.66 which was lower when compared to other diagnoses. There was an association between previous cesarean section and abdominal wall endometriosis (p <0.005).

CONCLUSION

the women with a diagnosis of abdominal wall endometriosis had undergone previous cesareans (the majority) and were in an active reproductive age. Although the brown skin women were the most frequent, there was no statistical difference.

Abdominal and perineal scar endometriosis: Retrospective study on 40 cases

OBJECTIVE(S)

Abdominal and perineal scar endometriosis usually develop in association with a prior surgical scar. The purpose of the study was to detect and review patients' characteristics of these women over a long period.

STUDY DESIGN

We retrospectively review the clinical records of 860 women with endometriosis between 1989 and 2019. Data were collected and analyzed from medical and pathological reports of 40 patients with abdominal and perineal scar endometriosis.

RESULTS

26 patients (3,0 %) were detected in the abdominal wall endometriosis group (AWE) (mean age 36,5 ± 3,4 years) and 14(1,6 %) cases in the perineal endometriosis (PE) group (32,5 ± 2,4 years), respectively. We observed that 92,3 % of women with AWE had undergone at least 1 cesarean section. Moreover, the majority of patients presented with abdominal pain (77, 0 %) and sensation of a mass (96,2 %). 15,4 % of cases had concurrent pelvic endometriosis and the recurrent rate of the disease was 15,4 %. All cases with perineal scar endometriosis were multiparous and delivered vaginally with episiotomy. 92,8 % of patients presented with cyclical pain and swelling. 3 cases suffered from perineal endometriosis combined with pelvic endometriosis. There was a recurrence of perineal endometriosis in 2 women (14,2 %). Surgical excision was the standard treatment of this condition and tissue biopsy confirmed the diagnosis.

CONCLUSIONS

Abdominal wall and perineal scar endometriosis are rare, multifactorial entities which are associated mainly with cesarean section and vaginal episiotomy. Clinicians should be aware of these conditions among all women of reproductive age presenting with cyclic or non-cyclic pain and swelling at the incision sites.

Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma

PURPOSE

To review the clinical, multimodality imaging, and pathologic characteristics of abdominal wall endometriosis (AWE), the most common type of extra-pelvic endometriosis.

METHODS

116 women with histopathologically confirmed extragenital endometriosis diagnosed between 2/2014 and 6/2017 were evaluated retrospectively. Of these, 26 (22.4%) were found to have AWE and 18/26 met inclusion criteria for imaging. Available imaging studies were re-reviewed by two expert radiologists. Data regarding clinical features, histopathologic findings, and management were collected through medical record review.

RESULTS

21 pathology-proven AWE deposits were identified by imaging in 18 women [mean age at diagnosis of 38.5 years (range 31-48)]. Prior C-section was present in 15/18 (83.3%) and pelvic endometriosis in 3/18 (16.7%) patients. Patients presented with abdominal pain in 14/18 (77.8%) cases, which was cyclical in 8/14; palpable mass in 12/18 (66.7%); fluid discharge in 2/18 (11.1%); and local skin discoloration in 2/18 (11.1%). Of the 21 lesions, 15 were evaluated with US, 10 with CT, and 5 with MRI. Mean lesion dimensions were 2.5 × 2.2 × 2.6 cm, and deposits were predominantly located at midline or left hemiabdomen [22/30 (73.3%)], were either stellate [15/30 (50%)] or round [15/30 (50%)] in shape, had ill-defined margins [21/30 (70%)], were heterogenous in appearance [27/30 (90%)], and involved both deep and superficial abdominal wall layers [17/30 (56.7%)]. On US, lesions were mainly isoechoic/hyperechoic [7/15 (46.7%)], and scarcely vascular [8/15 (53.3%)] with a peripheral vascular pattern [8/13 (61.5%)]. On CT, AWEs were hypervascular and homogeneous [8/10 (80%)], superiorly located to scar tissue, and on MRI lesions appeared hyperintense [4/5 (80%)] to muscle with T2 cystic and T1 hemorrhagic foci [4/5 (80%)]. In 23/27 (85.1%) original reports, there was at least one known mass prior to imaging; AWE was correctly diagnosed in only 7/23 (30.4%) cases. In those with no prior knowledge of a mass, the lesion was detected in 3/4 (75%), but AWE was only diagnosed in a single case. Median time between onset of symptoms and histopathology was 24.41 moths (IQR 15.18-47.33).

CONCLUSIONS

AWE is a challenging clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. Familiarity with its radiologic features holds the potential for positively impacting diagnosis.

Parietal Mass: Two Case Reports of Rare Cesarean Scar Endometriosis

Scar endometriosis is an uncommon type of extra-pelvic endometriosis. However, it should be suspected in any woman of childbearing age complaining of a cyclic, painful nodule in a scar from a previous obstetric or gynecologic procedure, after excluding other differential diagnoses. The treatment of choice is surgical resection. We report two cases of scar endometriosis that appeared in two young ladies after cesarean sections, discovered by a parietal mass near the cesarean scars.

Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature

Background

Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.

Introduction

Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations.

Case Report

A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition.

Discussion

The etiopathogenesis, presentation, investigations, and management are discussed briefly.

Conclusion

Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

A Rare Cause of Abdominal Pain: Scar Endometriosis

Introduction. Scar endometriosis (SE) is a rare pathology that develops in the scar tissue formed on the anterior abdominal wall usually after a cesarean section. There have been instances of women presenting to emergency or general surgery clinics with abdominal pain due to SE. Materials and Methods. This study retrospectively reviews 19 patients who were operated on in our clinic between January 2010 and January 2017 with a prediagnosis of SE and were reported to have SE based on their pathology results. Results. The mean age of the patients was 30.8 years (range: 20-49 years). The body mass indexes of 12 (63.2%) patients were ≥ 25. All patients had a history of cesarean section and 9 (47.4%) patients had undergone cesarean section once. With the exception of one patient who had her SE localized in her inguinal region, all patients had a mass localized on their anterior abdominal wall neighboring the incision and complained about cyclic pain starting in their premenstrual periods. The complaints began 2 years after their cesarean section in 10 (52.6%) patients. Mostly abdominal ultrasonography was used for diagnostic purposes. The lesions were totally excised and the SE diagnosis was made through a histopathological examination in all patients. No postoperative complications or recurrences were seen in any of the patients. Conclusion. Suspicion of SE is essential in women of reproductive age who have a history of cesarean section and complaints of an anterior abdominal wall mass and a pain at the scar site that is associated with their menstrual cycle. An accurate and early diagnosis can be established in such patients through a careful history and a good physical examination and possible morbidities can be prevented with an appropriate surgical intervention.

Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature

BACKGROUND

Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.

INTRODUCTION

Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations.

CASE REPORT

A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition.

DISCUSSION

The etiopathogenesis, presentation, investigations, and management are discussed briefly.

CONCLUSION

Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution

OBJECTIVE

To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci.

METHODS

All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed.

RESULTS

A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00 cm³ and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300 s of sonication time, 40 min treatment time, 150 W of power and 41800 J of total energy to treat lesions that were a median volume of 3.83 cm³. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women.

CONCLUSION

The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery.

Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings

Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic and multifocal disease with no known cure or preventive mechanisms. Patients may be asymptomatic or may experience chronic pelvic pain, dysmenorrhea, dyspareunia, or infertility. The pelvic cavity is the most common location for endometriotic implants, which usually affect the retrocervical space, ovaries, vagina, rectosigmoid colon, bladder dome, and round ligaments. Atypical endometriosis is rare and difficult to diagnose. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, umbilicus, inguinal area, breast, and pelvic nerves, as well as abdominal surgical scars. Gastrointestinal lesions are the most common extragenital manifestation, and the diaphragm is the most frequent extrapelvic site. The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) may help suggest the diagnosis, but imaging by specialists is fundamental to evaluation. Depending on the area affected, radiography, ultrasonography, thin-section computed tomography, or magnetic resonance imaging can be used to assess suspected lesions. Because isolated extragenital endometriosis is rare, concomitant evaluation of the pelvic cavity is mandatory. Surgical excision is the only therapeutic option for definitive treatment, and comprehensive disease mapping is necessary to avoid residual disease. The authors review atypical locations for endometriosis and emphasize the most appropriate imaging protocols for investigation of various clinical manifestations. Online supplemental material is available for this article. ^©RSNA, 2018.

Appendectomy Scar Endometriosis: A Case Report

Scar endometriosis is one of the rare cases of surgery, which specifically occurs in gynecological surgeries. It is important to do a correct diagnosis in such rare cases to have an efficient treatment. The disease is commonly observed in child-bearing women with clinical manifestations such as acute abdomen or chronic and cyclic pelvic pain. Herein we reported a case of appendectomy scar endometriosis.

Scar endometriosis: A case report and literature review

Introduction:

Surgical scar endometrioma is defined as the presence of an endometrial tissue near or inside an abdominal surgical incision. This is a rare clinical event that can occur in women after gynecological or obstetric surgery, with a global prevalence estimated at 0.01%–1%. The most prevalent clinical feature includes a painful mass with a cyclic pain that exacerbates with menstruation. The aim of this work is to facilitate the identification and support the diagnosis of abdominal wall endometrioma associated with the cesarean section scar, with basis on a case study of a tumor in the cesarean surgical scar of a patient who also complains of dyspareunia and menorrhagia.

Case report:

A 43-year-old female patient, G4PC4A0, with a single, rounded and painful subcutaneous nodule in the right inguinal region, on the cesarean section scar, which had progressively grown for two years. Patient also reported increased nodule size during menstrual period, associated with pain and menorrhagia. In February 2016, a surgical procedure was performed and by the post-surgical evaluation, the patient had already presented a menstrual cycle and reported decrease in symptoms. Biopsy report brought findings compatible with endometriosis.

Conclusion:

According to the literature, the clinical picture of the patient confirms the suspected endometrioma. The set of signals and symptoms associated with well-specified additional tests allowed an early and efficient diagnosis. The knowledge of the disease and the adoption of these criteria may mean a reduced burden on health services, but mainly, improve the quality of life of patients.

Effect of high-intensity focused ultrasound ablation on endometriosis of the abdominal wall

In this study, we aimed to explore the effect of high-intensity focused ultrasound (HIFU) ablation on endometriosis of the abdominal wall. A total of 25 patients with abdominal wall endometriosis were selected after HIFU treatment, and their demographic characteristics were retrospectively analyzed. The blood perfusion of focus before operation and the focus ablation during or after operation were evaluated using ultrasound contrast, and follow-up for 24 months. Thirty lesions were ablated in 25 patients. Intermittent pain disappeared 1 month after the operation, and patients' pain score significantly decreased, while the shrink ratio of lesions significantly increased with prolonged follow-up time. No severe complications were noted. HIFU ablation of abdominal wall endometriosis is an effective and safe method, with obvious long-term effects, and showed a significant guiding effect on the treatment of abdominal wall adenomyosis in the clinical setting.

Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature

Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.

Surgical scar endometriosis: a series of 14 patients and brief review of literature

Background and aims

Endometriosis is a commonly encountered disorder in women of reproductive age, consisting of the presence of active ectopic endometrial tissue outside the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnostic tools and therapeutic options in abdominal wall endometriosis (AWE).

Methods

We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution.

Results

The main characteristic of AWE were emphasized, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% of all cases an accurate diagnosis of AWE was established preoperatively.

Conclusion

A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased.

A Retrospective Study of 17 Patients who Had Excision of Abdominal wall Endometriosis after Caesarean Section over an 11-Year Period

Introduction

The aim of our study was to retrospectively learn about the incidence of abdominal wall endometriosis (AWE) after caesarean section (CS) in our Perinatal Centre (Perinatal Centre of the Institute for the Care of Mother and Child), one of the largest in the Czech Republic.

Methods

This is a retrospective review of hospital records on 18,454 caesarean deliveries between 2003 and 2014.

Results

A total of 17 cases of caesarean scar endometriosis (also known as AWE) were identified. The median age was 36.0 (33.5-43.5) years. In 10 patients, the cyclic pain was present. The median interval between CS and first symptoms was 3.0 (1.0-6.5) years. Ultrasound supported the diagnosis by the identification of hypoechogenic lesions in all patients. The median interval between symptoms development and surgical excision was 1.0 year (1.0-4.0 years). Excision was the mode of treatment. Excisions with clear margins (15 cases) were curative to all those patients. Two patients with involved margins had recurrences at 6 and 8 months, respectively, and were treated with a second resection with no further surgery. No malignant transformation cases were identified.

Conclusions

Physicians should be highly suspicious of CS scar endometriosis, especially after uterine surgery. Complete excision is the only curative treatment.

Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women

AIM

The prevalence of scar endometriosis is increasing with the increasing caesarean deliveries and laparoscopic procedures done for pelvic endometriosis. To analyse the symptomatology and surgical perspective of scar endometriosis.

MATERIALS AND METHODS

Retrospective review of 16 women who underwent surgery for scar endometriosis in the period of 4 years in Amrita institute of medical sciences.

RESULTS

Mean age of the patients is 35.19 years. Mean interval from the index surgery to the presentation is 4.56 years. Mean size of the swelling is 2.84 cm. In 68.8% of the patients, caesarean section was the inciting surgery. 18.7% had port site endometriosis. Cyclical pain and swelling at the scar site was present in 93.8% of the women. 18.9% had concurrent pelvic endometriosis. All women had involvement of the subcutaneous tissue followed by 11 women with the involvement of rectus sheath. There was no recurrence of the lesion in the operated patients in the mean follow-up period of 11.91 months.

CONCLUSION

In all women presenting with cyclical scar site pain and swelling, scar endometriosis should be considered. It commonly follows caesarean section and laparoscopic surgeries done for endometriosis. Wide local excision with or without reconstruction is the method of choice for this condition. Role of tumescent solution during surgery and postoperative medical management to reduce recurrence needs further prospective studies.

Abdominal wall endometrioma: Our experience in Vladimir, Russia

Background:

Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall.

Subjects and Methods:

A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed.

Results:

In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma.

Conclusion:

Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE.

An Abdominal Wall Desmoid Tumour Mimicking Cesarean Scar Endometriomas: A Case Report and Review of the Literature

Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature.