{"paper_id":"b3aae349-2f58-4d0c-a260-6ba56a3bf6dc","body_text":"Obstetrics and \nGynaecology Cases - Reviews\nCase Report: Open Access\nClinMed\nInternational Library\nCitation: Mei LL, Weng MHF (2015) Primary Umbilical Endometrioma: A Case Report. \nObstet Gynecol Cases Rev 2:061\nReceived: June 22, 2015: Accepted: September 28, 2015: Published: September 30, 2015\nCopyright: © 2015 Mei LL. This is an open-access article distributed under the terms of \nthe Creative Commons Attribution License, which permits unrestricted use, distribution, \nand reproduction in any medium, provided the original author and source are credited.\nMei and Weng. Obstet Gynecol cases Rev 2015, 2:6\nISSN: 2377-9004\nPrimary Umbilical Endometrioma: A Case Report\nLim Leek Mei* and Mickael Hoong Farn Weng\nSabah Women and Children’s Hospital, Kota Kinabalu Sabah, Malaysia\n*Corresponding author: Lim Leek Mei, Trainee in Obstetrics and Gynaecology Department, Sabah Women and \nChildren’s Hospital, Kota Kinabalu, Sabah, Malaysia, E-mail: leekiez@yahoo.com\nShe presented with scanty painless bleeding from the umbilicus \nfor past 5 months which coincided with her menses. The bleed would \nstart a few days before her menses and ceased by day two, in small \namount and painless. Her cycles were regular with normal flow \nand no dysmenorrhea. She also noted blackish discoloration of the \numbilicus. There was no other abnormal bleeding.\nOn examination, there was an umbilical nodule with dusky \nblue discoloration (Figure 1) with minimal bleeding, no other \npalpable abdominal mass. Vaginal examination was unremarkable. \nAbdominal-pelvic ultrasound and MRI were suggestive of umbilical \nendometrioma with suspicious implants in the sacrouterine ligament, \nuterus, vesicovaginal and bilateral ovaries.\nShe was counseled and opted for surgical intervention. She \nunderwent a wide local excision of umbilical endometrioma \nwith primary repair of the rectus in September 2014. A 2.2 × 2.5 \ncm supraumbilical pigmented lesion, adhered to omentum was \nresected with rectus breached. Histopathology examination showed \nendometrial glands and stroma, confirming the diagnosis (Figure 3 \nand Figure 4).\nAt 5 months post surgery, she was well with no disease recurrence \nIntroduction\nEndometriosis is a common gynaecological problem whereby \nthere is presence of endometrial glands and stroma outside the uterus. \nThis ectopic endometrium is predominantly found in the pelvis \nbut may be present anywhere in the body [1-5]. Primary umbilical \nendometrioma also known as Villar’s nodule is a very rare condition \nwhich incidence is reported to be 0.5-1% of all cases of extragenital \nendometriosis [1,2]. Due to its rarity, there are no clear guidelines on \nits treatment modalities. Main options in management are medical, \nsurgical or conservative after ruling out malignancy [1-5].\nCase Report\nWe report a case of primary umbilical endometrioma. She was a \n41year old lady, para 1+1 with a background history of type2 diabetes \nmellitus, hypertension and a previous uneventful Caesarean section \nin 2005. She was subfertile since then.\nFigure 1: Clinical appearance of umbilical nodule with dusky blue \ndiscoloration.\nFigure 2: 5 months post excision, picture showing a well healed transverse \nscar over umbilicus.\n\nMei and Weng. Obstet Gynecol cases Rev 2015, 2:6\n• Page 2 of 2 •ISSN: 2377-9004\nFine needle aspiration cytology (FNAC) is a fast and accurate way \nto confirm the diagnosis. MRI is non-specific but useful in determining \nthe extent of disease [2]. Surgical treatment (wide local excision with \nmargin of at least 1 cm) is recommended however patient should be \nwarned of recurrence although recurrence is rare if the excision is \nthorough [5,6]. At times when there is suspicion of concurrent pelvic \nendometriosis, a laparascopy can be performed at the same setting \n[5.6]. Hormonal treatment may lead to incomplete regression but \nmay be used to reduce its size for large umbilical endometrioma prior \nto excision which can improve the cosmetic outcomes [5,6].\nReferences\n1. Efremidou E, Kouklakis G, Mitrakas A, Liratzopoulos N, Polychronidis A \nCh (2012) Primary umbilical endometrioma: a rare case of spontaneous \nabdominal wall endometriosis. Int J Gen med 5: 999-1002.\n2. Fernandes H, Marla NJ, Pailoor K, Kini R (2011) Primary umbilical \nendometriosis-diagnosis by fine needle aspiration. J cytol 28: 214-216.\n3. (2010) OGRM. Endometriosis. \n4. RCOG Green Top Guidelines No.24 (2008) The investigations and \nmanagement of endometriosis.\n5. Carla IJ.M Theunissen, Frank F.A. IJpma (2015) Primary Umbilical \nEndometriosis: a cause of a painful umbilical nodule. J Surg Case Rep 3: \nrjv025.\n6. Treatment of extragenital endometriosis (2013) Management of women with \nendometriosis; Guideline of the European Society of Human Reproduction \nand Embryology.\nnor menstrual abnormality. On examination, there was a well healed \numbilical scar (Figure 2). She was a bit disappointed with the cosmetic \nappearance though.\nDiscussion\nEndometriosis involving abdominal wall is termed as cutaneous \nendometriosis which is commonly associated with surgical scar \nespecially caesarean section, laparascopy and amniocentesis [1,2]. \nEctopic endometrium occurring in abdominal wall in 0.03-1.08% of \nwomen with anamnesis of obstetrics or gynecology procedures [1]. \nPrimary umbilical endometrioma is a very rare entity whereby there \nare no preceding scars [1-5]. Its estimated incidence is 0.5-1% of all \ncases of extragenital endometriosis [1,2]. Several pathogenesis has been \npostulated however the real mechanism is still yet to be determined.  \nIt is believed that the disease may be arising from metaplasia of the \nurachal remnants in case of isolated umbilical endometrioma [2]. \nIt could be possible due to migration of endometrial cells to the \numbilicus through the abdominal cavity, the lymphatic system or \nthrough the embryonic remnants in the umbilical fold such as the \nurachus and the umbilical vessels [2,5].\nBased on our patient’s presentation, despite the classical complaint \nof cyclical bleed from the umbilical nodule during menstrual cycle, we \nstill have to be cautious of other differentials i.e. granuloma, lipoma, \nabscess, cyst, melanoma, primary or metastatic adenocarcinoma \n(sister joseph’s nodule), primary cancer of umbilicus (basal cell & \nsquamous cell carcinoma), Paget’s disease [5].\nHistology Examination:\nFigure 3 (Left): Low power shows skin with underlying endometrial glands and stroma.\nFigure 4 (Right): Hhigher power illustrate cystically dilated glands containing blood. The glands are lined by single layer cuboidal epithelium.\nInterpretation: Umbilical lump consistent with endometrioma","source_license":"CC0","license_restricted":false}