{"paper_id":"bfd34d2c-f666-4098-8078-c675cf475fed","body_text":"Mini Review \nISSN: 2574 -1241              DOI: 10.26717/BJSTR.2023.51.008118\nHormonal Therapy for Inguinal Endometriosis\nShiomi Ushida, Satoshi Ichigo, Hiroshi Takagi, Kazutoshi Matsunami, Hazuki Kagawa, Ichiro \nKawabata and Atsushi Imai*\nDepartment of Obstetrics and Gynecology, Matsunami General Hospital, Japan\n*Corresponding author: Atsushi Imai, Department of Obstetrics and Gynecology, Matsunami General Hospital, 185-1 Dendai, \nKasamatsu, Gifu 501-6062, Japan\nCopyright@ : Atsushi Imai | Biomed J Sci & Tech Res | BJSTR. MS.ID.008118. 42808\nABSTRACT\nInguinal endometriosis is an infrequent extragenital manifestation of endometriosis. Optimal management \ninvolves the radical surgical excision of the lesion, supplemented by hormone therapy. Recent case reports \nand retrospective analyses have indicated that hormone therapy utilizing gonadotropin-releasing hormone \nagonist, dienogest, or oral contraceptives is the preferred initial therapeutic approach when the patient \ndeclines surgery.\nAbbreviations: GnRHa: Gonadotropin-Releasing Hormone Agonist, OC: Oral Contraceptives, MR: Magnetic \nResonance \nARTICLE INFO\nReceived: \n   June 26, 2023\nPublished: \n   July 14, 2023 \nCitation: Shiomi Ushida, Satoshi Ichi -\ngo, Hiroshi Takagi, Kazutoshi Matsu -\nnami, Hazuki Kagawa, Ichiro Kawabata \nand Atsushi Imai. Hormonal Therapy \nfor Inguinal Endometriosis. Biomed \nJ Sci & Tech Res  51(3)-2023. BJSTR. \nMS.ID.008118.\nIntroduction\nEndometriosis is characterized by the presence of endometrio -\nsis-like tissues outside the uterine cavity [1,2]. It predominantly de -\nvelops lesions in the pelvic gonadal organs and rectovaginal pouch, \nless commonly affecting the gastrointestinal and urinary tracts, and \nrarely occurring at distant sites such as the umbilicus and thoracic \ncavity [3,4]. Inguinal endometriosis, an uncommon presentation of \nextra-pelvic endometriosis, typically manifests as a tender, fixed in -\nguinal mass of small size. This condition exhibits changes in mass \nsize and pain that correlate with the menstrual cycle. It is observed \nin approximately 0.5% of endometriosis cases [5,6]. Surgical inter -\nvention has been frequently reported as the optimal diagnostic and \ntherapeutic strategy [7-9], and, therefore, there is limited literature \non hormonal treatment.\nHormonal Treatment \n(Table 1) provides a summary of reported cases of inguinal endo-\nmetriosis managed through hormonal therapy. Tanaka and Umesaki \nreported complete remission of catamenial right inguinal pain and \nright shoulder joint pain associated with extraperitoneal endome -\ntriosis following gonadotropin-releasing hormone agonist (GnRHa) \ntherapy. Several cycles of oral contraceptive (OC) therapy exhibited \ninadequate effects on her both pain [10]. In a retrospective case se -\nries, 8 patients with inguinal endometriosis received hormonal treat-\nment without surgery. Dienogest demonstrated pain and swelling \nimprovement in 75% (3 out of 4) cases, although symptoms persisted \nin one case. Pain improved in 1 out of 4 patients receiving OC thera -\npy. Among the 3 cases showing no improvement, all experienced per-\nsisting pain. A small subset of patients did not receive any treatment \n[6,11]. We encountered a critical case featuring a painful mass in the \nright inguinal area, particularly during menstrual cycles. Three ad -\nministrations of gonadotropin-releasing hormone agonist (1.88mg) \nwith a 4-week interval led to complete remission of inguinal endome-\ntriosis and significant improvement of the ovarian lesion (Figure 1) \n(manuscript in preparation). \n\nCopyright@ : Atsushi Imai | Biomed J Sci & Tech Res | BJSTR. MS.ID.008118.\nVolume 51- Issue 3\nDOI: 10.26717/BJSTR.2023.51.008118\n42809\nTable 1: Reported cases of inguinal endometriosis with hormonal therapy.\nNo. Patient Age Symptoms Medicine Ref.\n1 41 Right inguinal mass and pain Dienogest [11]\n2 43 Right inguinal mass and pain Dienogest [11]\n3 42 Right inguinal mass and pain Dienogest [11]\n4 43 Right inguinal mass and pain Dienogest [11]\n5 27 Right inguinal mass and pain OC [11]\n6 34 Right inguinal mass and pain OC [11]\n7 31 Left inguinal mass and pain OC [11]\n8 29 Right inguinal mass and pain OC [11]\n9 47 Right inguinal pain and right shoulder pain GnRHa [10]\nCurrent case 41 Right inguinal mass and pain GnRHa\nFigure 1:\nA. A case of inguinal endometriosis. A 41-year-old woman presented with a painful mass in her right inguinal area, particularly during \nmenstrual cycles. Magnetic resonance imaging (MRI) sagittal images (T2-weighted) revealed a cystic mass (2 by 2 cm) in the right inguinal area \n(yellow arrow) and an ovarian lesion (white arrow). \nB. Three administrations of gonadotropin-releasing hormone agonist (1.88mg) with a 4-week interval led to complete remission of inguinal \nendometriosis and significant improvement of the ovarian lesion.\nDiscussion\nTheoretically, hormonal therapy, rather than surgical intervention, \nmay be considered the primary choice due to the multifocal nature \nof endometriosis in most patients [12,13]. In cases of severe inguinal \nendometriosis where surgery is not desired, the ideal medicinal treat-\nment should possess prolonged, curative, and safe properties capable \nof reducing endometriotic lesions. OC is highly safe medications with \nminimal adverse effects [14,15], making them a current first-choice \noption for maintenance therapy after remission-induction. However, \nOC therapy exhibits a slow onset of action, rendering it unsuitable for \nrapidly ameliorating symptoms. GnRHa therapy can promptly induce \ncomplete remission. Inguinal endometriosis is challenging to identify \nand often mistaken for more common conditions such as hernias, soft \ntissue tumors, lymphadenopathy, cysts, granulomas and hydroceles. \nCatamenial symptoms (e.g., variations in mass size and tenderness) \nand magnetic resonance (MR) imaging findings can raise suspicion \nfor inguinal endometriosis [4]. Frequently, patients undergo surgi -\ncal procedures with a preoperative diagnosis of hernia, and endo -\nmetriosis is incidentally discovered or identified through histologic \nexamination [6,16]. Surgical excision may be the treatment of choice \nfor inguinal endometriosis, but hormone medications can alleviate \nsymptoms associated with endometriosis and serve as an alternation \nfor patients who do not want surgery.\n\nCopyright@ : Atsushi Imai | Biomed J Sci & Tech Res | BJSTR. MS.ID.008118.\n42810\nVolume 51- Issue 3\nDOI: 10.26717/BJSTR.2023.51.008118\nConflict of Interest \nThe authors declare that they have no conflict of interest.\nReferences\n1. Vercellini P , Viganò P , Somigliana E, Fedele L (2014) Endometriosis: patho-\ngenesis and treatment. Nat Rev Endocrinol 10(5): 261-275. \n2. Zondervan KT , Becker CM, Missmer SA (2020) Endometriosis. N Engl J \nMed 382(13): 1244-1256. \n3. Hirata T , Koga K, Osuga Y (2020) Extra-pelvic endometriosis: a review. Re-\nprod Med Biol 19(4): 323-333. \n4. Dallaudière B, Salut C, Hummel V, Pouquet M, Piver P , et al. (2013) MRI \natlas of ectopic endometriosis. Diagn Interv Imaging 94(3): 263-280. \n5. Licheri S, Pisano G, Erdas E, Ledda S, Casu B, et al. (2005) Endometriosis \nof the round ligament: description of a clinical case and review of the liter-\nature. Hernia 9(3): 294-297. \n6. Dalkalitsis A, Salta S, Tsakiridis I, Dagklis T , Kalogiannidis I, et al. (2022) \nInguinal endometriosis: A systematic review. Taiwan J Obstet Gynecol \n61(1): 24-33. \n7. Niitsu N, Tsumura H, Kanehiro T , Yamaoka, H Taogoshi H, et al. (2019) \nClinical characteristics and surgical treatment for inguinal endometriosis \nin young women of reproductive age. Dig Surg 36(2): 166-172.  \n8. Wolfhagen N, Simons NE, de Jong KH, van Kesteren PJM, MP Simons MP \n(2018) Inguinal endometriosis, a rare entity of which surgeons should \nbe aware: clinical aspects and long-term follow-up of nine cases. Hernia \n22(5): 881-886. \n9. Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, et al. (1995) Presenta-\ntion of endometriosis to general surgeons: a 10-year experience. Br J Surg \n82(10): 1349-1351. \n10. Tanaka T , Umesaki N (2009) Complete remission of OC-resistant catame-\nnial shoulder joint pain and inguinal pain associated with extraperitoneal \nendometriosis following personalized GnRH agonist therapy. Clin Exp Ob-\nstet Gynecol 36(1): 46-48.\n11. Arakawa T , Hirata T , Koga K, Neriishi K, Fukuda S, et al. (2019) Clinical \naspects and management of inguinal endometriosis: A case series of 20 \npatients. J Obstet Gynaecol Res 45(10): 2029-2036. \n12. Khetan N, Torkington J, Watkin A, Jamison MH, Humphreys WV (1999) \nEndometriosis: presentation to general surgeons. Ann R Coll Surg Engl \n81(4): 255-259.\n13. Hirata A, Koga K, Osuga Y (2020) Extra-pelvic endometriosis: a review. \nReprod Med Biol 19(4): 323-333. \n14. Vercellini P , Buggio L, Frattaruolo MP , Borghi A, Dridi D, et al. (2018) Med-\nical treatment of endometriosis-related pain. Best Pract Res Clin Obstet \nGynaecol. 51: 68-91. \n15. Hee L, Kettner LO, Vejtorp M (2013) Continuous use of oral contracep -\ntives: an overview of effects and side-effects. Acta Obstet Gynecol Scand \n92(2): 125-136. \n16. Mu B, Zhang Z, Liu C, Zhang K, Li S, et al. (2021) Long term follow-up of \ninguinal endometriosis. BMC Womens Health 21(1): 90.\nSubmission Link: https://biomedres.us/submit-manuscript.php\nAssets of Publishing with us\n• Global archiving of articles\n• Immediate, unrestricted online access\n• Rigorous Peer Review Process\n• Authors Retain Copyrights\n• Unique DOI for all articles\nhttps://biomedres.us/\nThis work is licensed under Creative\nCommons Attribution 4.0 License\nISSN: 2574-1241\nDOI: 10.26717/BJSTR.2023.51.008118\nAtsushi Imai. Biomed J Sci & Tech Res","source_license":"CC0","license_restricted":false}