Bifocal endometriomas involving a Pfannenstiel incision. Clinical case

Bifocal endometriomas involving a Pfannenstiel incision. Clinical case DOI: https://doi.org/10.30978/GS-2024-3-48Keywords: extrapelvic endometriosis, scar endometriosis, abdominal wall endometriosis, caesarean sectionAbstract Endometrioma of the anterior abdominal wall (EAAW) is a rather rare variant of extragenital endometriosis, which in most cases occurs after obstetrical and gynecological procedures. EAAW presented predominantly as a single tumour‑like mass, and multiple ectopias were observed in only 1.9—5.6% of cases, exclusively after Pfannenstiel laparotomy. Here we present a clinical case of a 37‑year‑old patient who complained of the large tumour‑like nodules along the postoperative anterior abdominal wall scar, accompanied by severe cyclic, catamenial pain. Additionally, the patient noted an increase in tumour size during menstruation. Thirty‑three months ago, she underwent an elected cesarean section for obstetric indications. Based on ultrasonography and computed tomography scans, the presence of two EAAW in the corners of the postoperative scar was established: 46 × 32 × 31 mm and 14 × 18 × 13 mm, respectively. Both lesions were excised out without damaging their integrity. The fascial defect was replaced by synthetic polypropylene mesh. The diagnosis of EAAW was finally confirmed based on pathological (presence of endometrial glands and cytogenic stroma) and immunohistochemical (positive membrane expression of CD10 in cytogenic stroma, intense cytoplasmic expression of CK7 in endometrial glands, marked nuclear expression of progesterone (PR) and estrogen (ER‑α) receptors in endometrial glands and cytogenic stroma, proliferative activity index Ki‑67 — 2%) studies. At a follow‑up after 19 months, the patient was asymptomatic; according to physical examination and ultrasound scan, there was no evidence of recurrence. Abdominal wall endometriosis is a rare condition. Clinicians should be aware of this pathology, especially in women presenting with a painful mass near the scar of a previous obstetrical and gynecological surgery. Surgery is the best treatment modality for endometrioma, whereas its optimal volume is considered to be R0 resection with preservation of endometriomas’ integrity. The final diagnosis of EAAW requires pathological and immunohistochemical confirmation. References Allen SE, Rindos NB, Mansuria S. Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management. Curr Opin Obstet Gynecol. 2021;33(4):288-95. http://doi.org/10.1097/GCO.0000000000000714. Benedetto C, Cacozza D, de Sousa Costa D, et al. Abdominal wall endometriosis: Report of 83 cases. Int J Gynaecol Obstet. 2022;159(2):530-6. http://doi.org/10.1002/ijgo.14167. Cho YK, Kocol D, Harkins G, et al. An approach to abdominal-wall endometriosis: A retrospective case series. J Gynecol Surg. 2020;36(1):1-4. http://doi.org/10.1089/gyn.2018.0110. Cojocari N, Ciutacu L, Lupescu I, et al. Parietal endometriosis: A challenge for the general surgeon. Chirurgia (Bucur). 2018;113(5):695-703. http://doi.org/10.21614/chirurgia.113.5.695. Cope AG, Narahulu DM, Khan Z, et al. Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis. J Endometr Pelvic Pain Disord. 2020;12(1):41-50. http://doi.org/10.1177/2284026520906060. Foley CE, Ayers PG, Lee TT. Abdominal wall endometriosis. Obstet Gynecol Clin North Am. 2022;49(2):369-80. http://doi.org/10.1016/j.ogc.2022.02.013. Goksever Celik H, Karacan T, Kaya C, et al. Abdominal wall endometriosis: A monocentric continuous series and review of the literature. J Endometr Pelvic Pain Disord. 2019;11(2):95-101. http://doi.org/10.1177/2284026519834465. Hasan A, Deyab A, Monazea K, et al. Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section. Ann Med Surg (Lond). 2021;62:219-24. http://doi.org/10.1016/j.amsu.2021.01.029. Jaramillo-Cardoso A, Balcacer P, Garces-Descovich A, et al. Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma. Abdom Radiol (NY). 2020;45(6):1800-12. http://doi.org/10.1007/s00261-018-1666-1. Liu G, Wang Y, Chen Y, Ren F. Malignant transformation of abdominal wall endometriosis: A systematic review of the epidemiology, diagnosis, treatment, and outcomes. Eur J Obstet Gynecol Reprod Biol. 2021;264:363-7. http://doi.org/10.1016/j.ejogrb.2021.08.006. Lopez-Soto A, Sanchez-Zapata MI, Martinez-Cendan JP, et al. Cutaneous endometriosis: Presentation of 33 cases and literature review. Eur J Obstet Gynecol Reprod Biol. 2018;221:58-63. http://doi.org/10.1016/j.ejogrb.2017.11.024. Matalliotakis M, Matalliotaki C, Zervou MI, et al. Abdominal and perineal scar endometriosis: Retrospective study on 40 cases. Eur J Obstet Gynecol Reprod Biol. 2020;252:225-7. http://doi.org/10.1016/j.ejogrb.2020.06.054. Piriyev E, Namazov A, Mahalov I, et al. Clinical and surgical characteristics of abdominal wall endometriosis: A multicenter case series of 80 women. In Vivo. 2023;37(2):756-62. http://doi.org/10.21873/invivo.13138. Song H, Lee S, Kim MJ, et al. Abdominal wall mass suspected of endometriosis: clinical and pathologic features. Obstet Gynecol Sci. 2020;63(3):357-62. http://doi.org/10.5468/ogs.2020.63.3.357. Zhang P, Sun Y, Zhang C, et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. 2019;19(1):14. http://doi.org/10.1186/s12905-019-0711-8. Downloads Published How to Cite Issue Section License Copyright (c) 2024 Authors This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.