{"paper_id":"44fe3d32-6e9d-4cce-b567-323a7f806ac7","body_text":"Abstract\nPurpose\nTo established a strategy for diagnostic and therapeutic management of umbilical endometriosis and to determine the biological character.\nMethods\nClinical examination, vaginal and abdominal ultrasound, magnetic resonance imaging of the abdominal wall and laparoscopy were performed on a 42-year-old woman with umbilical endometriosis. Surgery with umbilical reconstruction was performed by a new plastic surgery technique. Immunohistochemical analyses (against Ki 67, estrogen/progestogen receptor, CD10, smooth muscle actin, desmin, caldesmon, von Willebrandt factor, cyclooxygensae-2 and VEGF) were done to characterize the umbilical endometriotic lesion.\nResults\nThe extension of the endometriotic lesion necessitated total removal of the umbilicus. Umbilical reconstruction was performed by a new plastic surgery technique. The lesion did express CD10, estrogen and progestogen receptors, and did show a moderate proliferation rate. Furthermore, signs of metaplastic processes such as smooth muscle metaplasia and angiogenesis were detected. The endometriotic lesion was positive not only for smooth muscle actin, caldesmon and desmin, but also for COX-2 and VEGF.\nConclusion\nBased on a case report and a literature review, we discuss the diagnostic and therapeutic management of umbilical endometriosis at our endometriosis research center. Furthermore, our data suggest that the umbilical endometriotic lesion originated from reactivated multipotent cells.\nSimilar content being viewed by others\nReferences\nLatcher JW (1953) Endometriosis of the umbilicus. Am J Obstet Gynecol 66:161–168\nMichowitz M, Baratz M, Stavorovsky M (1983) Endometriosis of the umbilicus. Dermatologica 167:326–330\nSingh KLAM, Adam DJ et al (1995) Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg 82:1349–1351. doi:10.1002/bjs.1800821017\nFrischknecht F, Raio L, Fleischmann A et al (2004) Umbilical endometriosis. Surg Endosc 18:347. doi:10.1007/s00464-003-4245-6\nPurvis RS, Tyring SK (1994) Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. J Dermatol Surg Oncol 20:693–695\nDaoudi K, Bongain A, Isnard V et al. (1995) Umbilical endometriosis. A case report. Rev Fr Gynecol Obstet 90:442–443\nvon Stemm AM, Meigel WN, Scheidel P et al (1999) Umbilical endometriosis. J Eur Acad Dermatol Venereol 12:30–32. doi:10.1016/S0926-9959(98)00099-3\nIgberase GO, Igbekoyi OF (2005) Umbilical endometriosis in a 45 year old Nigerian grandmultipara. Afr J Med Med Sci 34:193–194\nSidani MS, Khalil AM, Tawil AN et al (2002) Primary umbilical endometriosis. Clin Exp Obstet Gynecol 29:40–41\nBartsich S, Schwartz M (2002) Purse-String method for immediate umbilical reconstruction. Plast Reconstr Surg 112:1652–1655\nKokuba EM, Sabino NM, Sato H et al (2006) Reconstruction technique for umbilical endometriosis. Int J Gynaecol Obstet 94:37–40. doi:10.1016/j.ijgo.2006.04.034\nMeyer R (1930) Adenofibrosis und Adenomyosis am Nabel. In: Handbuch der Gynäkologie, vol 3. von Stöckel, Berlin, pp 511–515\nRoncoroni LCR, Violi V, Nunziata R (2001) Endometriosis on laparotomy scar. A three-case report. Arch Gynecol Obstet 265:165–167. doi:10.1007/s004040000153\nScott RT RW (1958) External endometriosis-the scourge of the private patient. Ann Surg 13:697–720\nSteck WHEB (1966) Cutaneus endometriosis. Clin Obstet Gynecol 9:373–383. doi:10.1097/00003081-196606000-00007\nMechsner S, Bartley J, Loddenkemper C et al (2005) Oxytocin receptor expression in smooth muscle cells of peritoneal endometriotic lesions and ovarian endometriotic cysts. Fertil Steril 83(Suppl 1):1220–1231. doi:10.1016/j.fertnstert.2004.11.038\nHasegawa T, Hasegawa F, Hirose T et al (2003) Expression of smooth muscle markers in so called malignant fibrous histiocytomas. J Clin Pathol 56:666–671. doi:10.1136/jcp.56.9.666\nTaylor R, Lebovic DI, Mueller MD (2002) Angiogenic factors in endometriosis. NY Acad Sci 955:89–100\nConflict of interest statement\nNone.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nMechsner, S., Bartley, J., Infanger, M. et al. Clinical management and immunohistochemical analysis of umbilical endometriosis. Arch Gynecol Obstet 280, 235–242 (2009). https://doi.org/10.1007/s00404-008-0900-4\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-008-0900-4","source_license":"CC0","license_restricted":false}