{"paper_id":"bd94f5d5-94b8-49e6-b1f8-beca0a6b3c28","body_text":"Submit Manuscript | http://medcraveonline.com\nIntroduction\nEndometriosis is the presence of endometrial tissue outside \nthe uterus, most commonly consisting of both endometrial glands \nand stroma. 1 Endometriosis generally involves ovary and pelvic \nperitoneum but it can also be found in extra gonadal sites like \nbowel, bladder, lung and rarely abdominal wall. 2 Though it can \ninvolve a variety of extra uterine locations but is less commonly \nfound cutaneously/subcutaneously. 3 Most of the abdominal wall \nendometriosis occurs within surgical scars with only few spontaneous \ncases.4 Spontaneous abdominal wall endometriosis (AWE) is presence \nof ectopic endometrium found superficial to peritoneum without the \nexistence of any previous scar. The aim of this case report is to remind \nthat some very rare site may be involved in endometriosis.4 \nCase presentation\nA 35-year-old female without any previous operative history, \npresented to the surgery outpatient clinic with the history of suprapubic \nswelling 1x1cm2 which was associated with pain and increase in size \nof the swelling during menstruation. Diagnosis of endometriosis \nwas made clinically. Ultrasound of the abdomen reveal normal scan. \nBilateral ovaries and bowel were normal. Ultrasound guided fine \nneedle aspiration cytology (FNAC) from the swelling reveal cellular \nsmears containing epithelial cells arranged in monolayered sheets \nhaving evenly spaced small round nucleus, bland nuclear chromatin, \nmoderate amount of cytoplasm and distinct cell border (Figure 1).  \nBackground comprised of variable amount of stromal fragments \nhaving spindle cells (Figure 2), lymphocytes, hemosiderin laden \nmacrophages and necrotic cell debris (Figures 3) (Figure 4).\nAdv Cytol Pathol. 2017;2(4):114‒115 114\n© 2017 Paudyal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nSpontaneous abdominal wall endometriosis \ndiagnosed by fine needle cytology: a case report\nVolume 2 Issue 4 - 2017\nPaudyal P ,1 Pradhan A,1 Dahal M,1 Pokharel \nS,1 Shah N,1 Paudyal P2\n1Department of Pathology, B P Koirala Institute of Health \nSciences, Nepal\n2Department of General Surgery, B P Koirala Institute of Health \nSciences, Nepal\nCorrespondence: Punam Paudyal, Department of Pathology, \nB P Koirala Institute of Health Sciences, Dharan, Nepal, T el: 977-\n9842040269; Email: punam.paudyal@bpkihs.edu\nReceived: June 28, 2017 | Published: September 11, 2017\nAbstract\nEndometriosis is presence of tissue histologically similar to endometrium outside \nof the uterine cavity, most commonly consisting of both endometrial glands and \nstroma. Spontaneous abdominal wall endometriosis is any ectopic endometrium \nfound superficial to the peritoneum without the presence of any previous scar. We \nreport here a case presented with suprapubic swelling which was associated with \ncyclical symptoms as well. Ultrasound guided fine needle aspiration done from the \nswelling reveal cytologic features of endometriosis. Considering the site diagnosis of \nspontaneous abdominal wall endometriosis was made. The aim of this case report is \nto remind that some very rare site may be involved in endometriosis and cytology can \nprovide accurate preoperative diagnosis of endometriosis.\nKeywords: abdominal wall endometriosis, spontaneous, fine needle cytology\nAdvances in Cytology & Pathology\nCase Report\n Open Access\nFigure 1 Smear reveal monolayered sheet of epithelial cells having bland nucleus and distinct cell border (PAP 40X).\n\n\nSpontaneous abdominal wall endometriosis diagnosed by fine needle cytology: a case report\n115\nCopyright:\n©2017 Paudyal et al.\nCitation: Paudyal P , Pradhan A, Dahal M, et al. Spontaneous abdominal wall endometriosis diagnosed by fine needle cytology: a case report. Adv Cytol Pathol. \n2017;2(4):114‒115. DOI: 10.15406/acp.2017.02.00030\nFigure 2 Stromal fragment having spindle cells (PAP 40X).\nFigure 3  Singly scattered hemosiderin laden macrophages against a \nhemorrhagic background (PAP 40X).\nFigure 4 Smear reveals both stromal (arrow) and endometrial epithelial cell \n(arrow head) arranged in monolayer sheet (PAP 4X).\nDiscussion\nSpontaneous abdominal wall endometriosis is presence of ectopic \nendometrium found superficial to peritoneum without the existence \nof any previous scar. 4 It is a rare entity, accounting for 20% of all \nabdominal wall endometriosis.4 Different pathophysiological theories \nconcerning the origin of endometriosis have been proposed, including \nthe implantation or reflux, direct extension, coelomic metaplasia, \ninduction, and lymphatic and vascular metastasis. 3 Lymphatic spread \nhas been suggested for spontaneous endometriosis based on the \ndemonstration of lymphatics between the pelvis and umbilicus. 3 The \nmost common site of spontaneous endometriosis is the umbilicus, \nfollowed by the inguinal area and the abdominal wall. 5 Cutaneous \nendometriosis could be suspected in women of reproductive age \npresenting with palpable abdominal bluish nodule, characterized by \ncyclic pain and swelling.2 These findings are similar to our case study. \nImaging studies are non-specific; thus, a biopsy is necessary to make \na definitive diagnosis. Endometriosis should be considered in the \ndifferential diagnosis of abdominal wall lesions even if not associated \nwith a scar of a previous operation. 6 It may be mistaken clinically \nfor lipoma, dermoid cyst, haemangioma, keloid, hernia, abscess, \npyogenic or foreign body granuloma, embryological rests, irreducible \nhernia, inclusion cyst, metastatic tumors from intraabdominal \nmalignancy and melanoma.2 Local recurrence after adequate surgical \nexcision is rare. Malignant transformation has been described. 7 \nRecognizing cutaneous endometriosis is very important for a prompt \nendometriosis’ diagnosis, as endometriosis is a progressive disease, \ndelaying diagnosis and treatment would increase the risk of severe \npain, distortion of the pelvic anatomy and sterility.8\nConclusion \nSpontaneous abdominal wall endometriosis, though a rare entity \ncan be considered in the differential diagnosis of all women of \nreproductive age group presenting with abdominal wall swelling and \ncyclic symptoms. Fine needle aspiration cytology can provide a safe, \nminimally invasive, cost effective and accurate preoperative diagnosis \nof endometriosis to plan a better surgical approach.\nAcknowledgements\nNone.\nConflict of interest\nThe author declares no conflict of interest.\nReferences\n1. Kumar V , Abbas AK, Fausto N, et al. Robbins and Cotran Pathologic \nBasis of Disease. 8th ed. USA: Saunders Elsevier; 2010. 1464 p. \n2. Pacchiarotti A, Milazzo GN, Gentile V , et al. concurrent spontaneous \numbilical and abdominal wall endometriosis retracting the surrounding \ncutis. International Journal of Case Reports in Medicine. 2013;2013:4.\n3. Raddaoui E, Ameeri S. Abdominal wall endometriosis: a report of \n2 cases with primary diagnosis by fine needle aspiration. Acta Cytol . \n2010;54(2):214–216.\n4. Clement PB. Disease of the peritoneum. In: Kurman RJ. editor. \nBlaustein’ s pathology of the female genital tract. USA: Springer; 2002. \np. 729–789.\n5. Kyamidis K, Lora V , Kanitakis J. Spontaneous cutaneous umbilical en-\ndometriosis: report of a new case with immunohistochemical study and \nliterature review. Dermatol Online J. 2011;17(7):5.\n6. Ideyi SC, Schein M, Niazi M, et al. Spontaneous endometriosis of the \nabdominal wall. Dig Surg. 2003;20:246–248.\n7. Chene G, Darcha C, Dechelotte P, et al. Malignant degeneration of peri-\nneal endometriosis in episiotomy scar, case report and review of the liter-\nature. International Journal of Gynecological Cancer. 2007;175(3):709–\n714.\n8. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endome-\ntriosis. Fertil Steril. 2012;98(3):54–59.","source_license":"CC0","license_restricted":false}