{"paper_id":"d28cac9a-93a5-4876-aa24-83e277e4dd59","body_text":"ndometriosis is the presence of functional endometrial glands and\nstromaoutsidetheuterinecavity.1,2 Extrapelvicendometriosisrefers\ntoendometriosisfoundatbodysitesotherthanthepelvis.1,2\nEndometriosisoftheabdominalwallisasubtypeofextrapelvicendo9\nmetriosis.Commonpresentationincludespalpablemass,cyclicpainduring\nthe menstruation, bleeding and discharge. Differential diagnosis includes\nabscess,lipoma,hematoma,sebaceouscyst,suturegranuloma,inguinalher9\nnia,incisionalhernia,desmoidtumor,sarcoma,lymphomaandprimaryor\nmetastaticcancer.1\nTurkiyeKlinikleriJMedSci2011;31(6) 1599\nSurgicalScarand\nRectusAbdominusMuscleEndometriosis:\nAReportofTwoCases\nA BS TRA C T En do met ri o sis is the pre sen ce of func ti o nal en do met ri al glands and stro ma out si de the\nute ri ne ca vity. The ab do mi nal wall is an un com mon si te of ex tra pel vic en do met ri o sis, whe re it usu9\nally de ve lops in an old sur gi cal scar. Com mon pre sen ta ti on inc lu des a pal pab le mass, cyclic pa in du 9\nring mens tru a ti on, ble e ding and disc har ge. Dif fe ren ti al di ag no sis inc lu des abs cess, li po ma,\nhe ma to ma, se ba ce o us cyst, su tu re gra nu lo ma, in gu i nal her ni a, in ci si o nal her ni a, des mo id tu mor, sar9\nco ma, lympho ma and pri mary or me tas ta tic can cer. En do met ri o sis in vol ving the rec tus ab do mi nis\nmusc le is al so a ra re con di ti on. We pre sent two ca ses of ex tra pel vic en do met ri o sis; one is a sur gi 9\ncal skin scar (Pfan nens ti el Ca e sa re an sec ti on ci cat rix) en do met ri o sis and the ot her is a rec tus ab do 9\nmi nus en do met ri o sis.\nKey Words: En do met ri o sis; rec tus ab do mi nis; ci cat rix \nÖZET En do met ri o zis ute rus boş lu ğu dı şın da fonk si yo nel en do met ri al bez le rin ve stro ma nın var lı 9\nğı dır. Ka rın du va rı pel vis dı şı en do met ri o zi sin na dir gö rül dü ğü bir yer dir ve bu ra da ge nel lik le es ki\nbir cer ra hi skar üze rin de ge li şir. Sık baş vu ru şek li pal pab le kit le, adet sı ra sın da sik lik ağ rı, ka na ma\nve akın tı dır. Ayı rı cı ta nı ap se, li pom, he ma tom, se ba se kist, di kiş gra nü lo mu, ka sık fı tı ğı, in siz yo 9\nnel her ni, des mo id tü mör, sar kom, len fo ma ve pri mer ve ya me tas ta tik kan se ri içe rir. Rek tus ab do 9\nmi nis ka sı nı tu tan en do met ri o zis ay rı ca na dir bir du rum dur. Biz pel vis dı şı en do met ri o zis li iki ol gu\nsun mak ta yız; bi ri cer ra hi cilt ska rı (Pfan nens ti el se zer yan ke si ska rı) en do met ri o zi si ve di ğe ri de bir\nrek tus ab do mi nis en do met ri o zi si.\nA nah tar Ke li me ler:En do met ri oz; rek tus ab do mi nis; skat ris  \nTurkiye Klinikleri J Med Sci 2011;31(6):15999601\nFazlı DEMİRTÜRK, MD,a\nAhmet Cantuğ ÇALIŞKAN, MD,a\nHakan AYTAN, MD,a\nR. Doğan KÖSEOĞLU, MDb\nDepartments of \naObstetrics and Gynecology,\nbPathology, \nGaziosmanpaşa University \nFaculty of Medicine, Tokat\nGe liş Ta ri hi/Re ce i ved: 23.11.2009 \nKa bul Ta ri hi/Ac cep ted:06.03.2010\nYa zış ma Ad re si/Cor res pon den ce:\nFazlı DEMİRTÜRK, MD\nGaziosmanpaşa University \nFaculty of Medicine, \nDepartment of \nObstetrics and Gynecology, Tokat,\nTÜRKİYE/TURKEY \nfazlimd@yahoo.com\ndoi:10.5336/medsci.2009f16228 \nCop yright © 2011 by Tür ki ye Kli nik le ri\nOLGU SUNUMU   \n\nThe ab do mi nal wall is an un com mon si te of\nex tra pel vic en do met ri o sis,  which usu ally de ve lops\nin an old sur gi cal scar. En do met ri o sis in vol ving the\nrec tus ab do mi nis musc le is al so a ra re con di ti on.1 \nWe pre sent two ca ses of ex tra pel vic en do met 9\nri o sis; one is a sur gi cal skin scar [Pfan nens ti el Ca e 9\nsa re an sec ti on (C/S) scar] en do met ri o sis whi le the\not her is a rec tus ab do mi nus en do met ri o sis. Both\npa ti ents ga ve the ir ver bal in for med con sent re gar 9\nding pub li ca ti on.\nCA SE RE PORTS\nCA SE 1\nThe pa ti ent was 31 ye ars old. She had two births\nwith C/S. Her last C/S was seven ye ars ago. She\ncomp la i ned of cyclic swel ling and pa in just be low\nher C/S scar for the previous four months. Du ring\nphysi cal exa mi na ti on, the re was a so lid and pa in ful\nmass of 5 x 5 cm un der her C/S scar and a blu e9\npurp le skin co lor over the mass. Magnetic reso9\nnance imaging sho wed a mass of ap pro xi ma tely 5 x\n5 cm in the sub cu ta ne o us tis su e(Fi gu re 1A). Du r9\ning sur gery,a 5 x 5 cm firm tis su e was ex cised. The\nhis topat ho logicre sult con fir med en do met ri o sis(Fi 9\ngu re 1B, C). She was disc har ged from the hos pi tal\nthe day af ter  sur gery. We ad mi nis te red two do ses\nof 11.5 mg le up ro li de ace ta te thre e months apart. \nCA SE 2\nThe pa ti ent was 26 ye ars old. She had a me di cal\nhis tory of a C/S in ye ar2001 and two la pa ro to mi es\nfor en do met ri o ma.She comp la ined of de ep, con ti 9\nnu o us low ab do mi nal pa in for six months. Her ul9\ntra so und exa mi na ti on sho wed no evidence of\nen do met ri o ma in ova ri es, and the ute rus was nor9\nmal. On physi cal exa mi na ti on, she had pa in in the\nlower part of rec tus ab do mi nis musc le. The re was\nno mass in the pa in ful re gi on, but the are as which\nwe re pa in ful and ten der we re stif fer than the nor9\nmal musc le tis su e. Du ring sur gery; the lower part\nof rec tus musc les we re hard and had a black co lor\n(Fi gu re 2A). The ex ci si on of the ab nor mal tis su e\nwas dif fi cult and was car ri ed out with scal pel rat her\nthan scis sors. Histopathologic re sult was en do met 9\nri o sis of rec tus musc les(Fi gu re 2B, C).She was dis9\nc har ged from hos pi tal the day af ter the sur gery.\nWe ad mi nis te red two do ses of 11.5 mg le up ro li de\nace ta te of for thre e months apart.\nDIS CUS SI ON\nEn do met ri o sis, a di sor der aff lic ting as many as 59\n10% of wo men of child be a ring age, is de fi ned as\nthe pre sen ce of func ti o nal en do met ri al glands and\nstro ma out si de the ute ri ne ca vity.\n1 The most wi 9\ndely ac cep ted the ory is that en do met ri o sis re sults\nfrom ret rog ra de mens tru a ti on.2 Ex tra pel vic en do 9\nmet ri o sis can in vol ve al most every or gan in the hu 9\nman body with a me an age of pre sen ta ti on of 34\nye ars.\n2 For cu ta ne o us en do met ri o sis, the imp lan ta 9\nti on of in tra9ab do mi nal en do met ri al cells most li 9\nkely oc curs thro ugh lympha tic or vas cu lar spre ad,\nor by dis lo ca ting en do met ri al tis su e du ring sur gery,\nsuch as la pa ros co pic pro ce du res.\n2 The se ro u tesex9\nTurkiye Klinikleri J Med Sci 2011;31(6)1600\nDemirtürk ve ark. Kadın Hastalıkları ve Doğum\nA B C \nFIGURE 1: A: Magnetic resonance imaging of subcutaneous endometriosis mass.\nB: Endometrial gland in scar tissue showing light hemorrage (HE, X20).\nC: Damaged endometrial gland in scar tissue showing heavy hemorrage (HE, X20).\n\np la in the oc cur ren ce of en do met ri o sis at dis tant lo9\nca ti ons.2 Rec tus ab do mi nis en do met ri o ma is ra re,\nwhe re in the en do met ri al fo cus is so lely con fi ned\ntherec tus ab do mi nis musc le and spar sely re por ted\nin li te ra tu re\n2 with only 11 new ca ses sin ce it was\nfirst des cri bed in 1993 by Co ley.3Ex tra pel vic en9\ndo met ri o sis has an in ci den ce of 8.9%, as re por ted in\nli te ra tu re.1\nIt may in vol ve pe ri to ne um, the uri nary blad9\nder and the ure ter, the lungs, the gall blad der, the\nbre asts, theex tre mi ti es, the co lon and the rec tum.\nEn do met ri o sis of the ab do mi nal wall has an in ci 9\nden ce of 4% and is ma inly lo ca li zed at sur gi cal\nscars, at the um bi li cus and ra rely at the in gu i nal ca 9\nnal or the rec tus ab do mi nis musc le.\n1The tre at ment\nfor en do met ri o tic fo ci in the rec tus ab do mi nis mus9\nc le is usu ally sur gi cal,1,4but can al so be ob ser va ti o 9\nnalde pen ding on the se ve rity of symptoms. Le up 9\nro li de ace ta te is com monly used in in tra pe ri to ne al\nand ex tra pe ri to ne al en do met ri o sis ca ses for re li e 9\nving symptoms. In both ca ses, we used le up ro li de\nace ta te af ter the ope ra ti ons.\nCONC LU SI ON\nEn do met ri o sis sho uld be considered in the dif fe 9\nren ti al di ag no sis in the work9up of a mass in the ab9\ndo mi nal wall of sub cu ta ne o us tis su e in yo ung\nwo men du ring child be a ring age, es pe ci ally if the re\nis a his tory of ab do mi nal or pel vic sur gery. Alt ho ugh\ncyclic pa in is cha rac te ris tic for en do met ri o sis; even\nif the pa in is not cyclic but con ti ni o us the sur ge on\nsho uld still con si der pos si bi lity of en do met ri o sis.\nTurkiye Klinikleri J Med Sci 2011;31(6) 1601\nGynecology and Obstetrics Demirtürk et al\nA B C \nFIGURE 2: A: Rectus muscle piece with endometriosis.\nB: Multiple endometriosis foci in rectus muscles (Arrows) (HE, X5).\nC: Close up view of  an endometrial focus. Endometrial gland formation in cellular endometrial stroma (HE, X15).\n1. Gourgiotis S, Veloudis G, Pallas N, Lagos P,\nSalemis NS, Villias C. Abdominal wall enf\ndometriosis: report of two cases. Rom J Morf\nphol Embryol   2008;49(4):553f5.\n2. Witz CA. Current concepts in the pathogenef\nsis of endometriosis. Clin Obstet Gynecol\n1999;42(3):566f85.\n3. Coley BD, Casola G. Incisional endometrioma\ninvolving the rectus abdominis muscle and\nsubcutaneous tissues: CT appearance. AJR\nAm J Roentgenol 1993;160(3):549f50.\n4. Cevrioğlu S, Yılmaz S, Yılmazer M, Tokyol Ç.\n[Endometriosis in cesarean scar: a case presf\nentation and literature review]. Turkiye\nKlinikleri J Gynecol Obst 2004;14(1):44f7.\nREFERENCES","source_license":"CC0","license_restricted":false}