Caesarean section scar endometriosis: quo vadis?

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Caesarean section scar endometriosis: quo vadis? window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-MKLVK7B5B6'); .articleTxt{ top: -16px; } .scielo__border-top{ border-top: 1px solid #ccc !important; } @media (max-width: 575.98px) { .articleCtt > .container{ padding-left: 0; padding-right: 0; } .articleCtt .articleTxt{ padding-left: 16px !important; padding-right: 16px !important; } } @media (min-width: 768px){ .scielo__truncate{ display: block; max-width: 285px; } } menu Menu Brazil Journal list by title Journal list by subject area Search Metrics (abre em nova aba) Sobre o SciELO Brazil Contacts Report error SciELO.org - The SciELO Network (abre em nova aba) National and thematic collections (abre em nova aba) Journal list by title (abre em nova aba) Journal list by subject (abre em nova aba) Search (abre em nova aba) Metrics (abre em nova aba) OAI and RSS (abre em nova aba) About the SciELO Network (abre em nova aba) Contacts (abre em nova aba) Blog SciELO in Perspective (abre em nova aba) document.addEventListener('DOMContentLoaded', function () { const wrapper = document.getElementById('scieloMainMenu'); const toggle = document.getElementById('scieloMainMenuToggle'); const panel = document.getElementById('scieloMainMenuNav2'); if (!wrapper || !toggle || !panel) return; const icon = toggle.querySelector('.material-icons-outlined'); const focusableSelector = [ 'a[href]', 'button:not([disabled])', 'input:not([disabled])', 'select:not([disabled])', 'textarea:not([disabled])', '[tabindex]:not([tabindex="-1"])' ].join(','); function setIcon(iconName) { if (icon) { icon.textContent = iconName; } } function getFocusableItems() { return Array.prototype.slice.call(panel.querySelectorAll(focusableSelector)) .filter(function (item) { return item.offsetParent !== null; }); } function openMenu() { panel.hidden = false; toggle.setAttribute('aria-expanded', 'true'); wrapper.classList.add('is-open'); setIcon('close'); const focusableItems = getFocusableItems(); if (focusableItems.length) { focusableItems[0].focus(); } } function closeMenu(options) { const settings = options || {}; panel.hidden = true; toggle.setAttribute('aria-expanded', 'false'); wrapper.classList.remove('is-open'); setIcon('menu'); if (settings.restoreFocus) { toggle.focus(); } } function isMenuOpen() { return toggle.getAttribute('aria-expanded') === 'true'; } toggle.addEventListener('click', function (event) { event.preventDefault(); event.stopPropagation(); if (isMenuOpen()) { closeMenu({ restoreFocus: true }); } else { openMenu(); } }); panel.addEventListener('click', function (event) { event.stopPropagation(); }); document.addEventListener('click', function (event) { if (isMenuOpen() && !wrapper.contains(event.target)) { closeMenu(); } }); document.addEventListener('keydown', function (event) { if (!isMenuOpen()) return; if (event.key === 'Escape') { event.preventDefault(); closeMenu({ restoreFocus: true }); return; } if (event.key !== 'Tab') return; const focusableItems = getFocusableItems(); if (!focusableItems.length) return; const firstItem = focusableItems[0]; const lastItem = focusableItems[focusableItems.length - 1]; if (event.shiftKey && document.activeElement === firstItem) { event.preventDefault(); toggle.focus(); return; } if (!event.shiftKey && document.activeElement === toggle) { event.preventDefault(); firstItem.focus(); return; } if (!event.shiftKey && document.activeElement === lastItem) { closeMenu(); } }); }); Brazil language en English Português Español Revista da Associação Médica Brasileira Mostrar opções launch Submission of manuscripts info About the journal help_outline Política editorial people Editorial Board help_outline Instructions to authors email Contact show_chart Metrics home Table of contents navigate_before previous (indisponível) current next navigate_next Text (EN) Text (English) PDF Download PDF (English) article Conteúdo: Text (EN) Text (English) Download PDF (English) (abre em nova aba) share Whatsapp BlueSky Mastodon Facebook Mais home Table of contents share Whatsapp BlueSky Mastodon Facebook Mais Text (EN) Text (English) PDF Download PDF (English) (abre em nova aba) Editorial • Rev. Assoc. Med. Bras. 68 (1) • Jan 2022 • https://doi.org/10.1590/1806-9282.20211074 link copy Caesarean section scar endometriosis: quo vadis ? About the editors SCIMAGO INSTITUTIONS RANKINGS Endometriosis is characterized by the presence of endometrial tissue implants outside the uterine cavity that responds to hormonal stimulation. These implants can be detected in all areas surrounding the uterus, ovaries, posterior cul-de-sac, ligaments of the uterus, pelvic peritoneum, and rectovaginal septum. Endometriosis may be infrequently found in the thorax, gastrointestinal tract, appendix, urinary tract, central nervous system, nose, umbilicus, lower limbs, and cutaneous cellular tissues. Caesarean scar endometriosis, id est , the cutaneous endometriosis, is the most common extrapelvic form, vulgo , and is located in scars following obstetric and/or gynecologic surgical procedures, such as caesarean delivery, hysterotomy, hysterectomy, episiotomy, ectopic pregnancy, salpingostomy, and tubal ligations, but scarcely in scars following appendicectomy, in the laparoscopic trocar and amniocentesis needle tracts. Diagnosis of surgical scar endometriosis following caesarean section, possessing an incidence of 0.03–0.4%, is not an easy process due to being often mistaken for a suture granuloma, lipoma, abscess, cyst, desmoid tumors, malignancies, incisional hernia, or a strange body 1 – 5 . Cellular transport theory, coelomic metaplasia theory, and the endometrial tissue reaching the surgical scar through the lymphatic or vascular pathways in order to develop into scar endometriosis afterward are accused and argued in the pathophysiology of the disease, to date 5 . Although mass in a caesarean section scar with symptoms of cyclic pain associated with menstruation is nearly pathognomonic, imaging modalities assist in identifying the condition. In spite of all odds, histopathologic evaluation is the major tool for confirmation 1 – 4 . Surgical scar endometrioses are known as possessing a potential for the progression of transformation, which rarely transpires for the malignant degeneration, accounting for 0.3–1% 1 , 6 . Herein, the interval of time from the onset of the benign lesion to the development of malignant form in caesarean section scar endometriosis has been defined as a broad variation, ranging from 3 to 39 years with a mean of 17 years 1 , 7 . In the upfront surgery setting, in particular, wide surgical excision with a safety margin with or without reconstruction has been recommended for the surgical procedures of endometriosis, per se, the gold standard treatment of choice 1 , 6 . As well as to avoid the possible transformation, some authors recommend a wide excision with at least 10 mm margins in order to prevent the recurrence 6 . Some authors recommended surgical resection with margins at least 5 mm in diameter and depth 8 , 9 . Although the pathogenesis of endometriosis is not precisely known, immunologic factors, metaplasia, and confounding factors such as diagnosis of endometriosis before the first delivery, breastfeeding, previous surgery, and hormonal contraception are important. Theoretically, pregnancy, per se , a state of the altered immune response, and caesarean section could augment the risk of developing endometriosis. Some authors emphasized that the cases with two caesarean sections did not augment the risk of being diagnosed with endometriosis, compared with one caesarean section. In addition, it was stated that those who diagnosed with caesarean scar endometriosis after the first caesarean section are no longer at risk of developing endometriosis for the first time. Inter alia, some authors proclaimed that caesarean scar endometriomas are more common after unlabored caesarean sections 10 , 11 . In fine, bene diagnosticur, bene curatur. Reddite ergo quae sunt Caesaris, Caesari. Funding: none. ACKNOWLEDGMENTS The authors thank all the participants. REFERENCES 1 Sengul I, Sengul D, Soares Junior JM. Interpretations on a rare localization of endometriosis: labium minus. Rev Assoc Med Bras (1992). 2021;67(1):1-2. https://doi.org/10.1590/1806-9282.67.01.001 » https://doi.org/10.1590/1806-9282.67.01.001 2 Sengul I, Sengul D, Kahyaoglu S, Kahyaoglu I. Incisional endometriosis: a report of 3 cases. Can J Surg. 2009;52(5):444-5. PMID: 19865584 3 Sengul D, Sengul I. Scar endometriosis: a review. Remedy Open Access. 2016;1(1): 1038. 4 Sengul I, Sengul D. Clinical presentation of incisional (cesarean section scar) endometriosis vary with the size of the lesion. Erciyes Med J. 2011;33(2):171-2. 5 Nominato NS, Prates LFVS, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):83-5. https://doi.org/10.1016/j.ejogrb.2010.05.001 » https://doi.org/10.1016/j.ejogrb.2010.05.001 6 Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-section scar endometrioma: a case report and review of the literature. J Radiol Case Rep. 2017;11(12):16-26. https://doi.org/10.3941/jrcr.v11i12.3178 » https://doi.org/10.3941/jrcr.v11i12.3178 7 Matter M, Schneider N, McKee T. Cystadenocarcinoma of the abdominal wall following caesarean section: case report and review of the literature. Gynecol Oncol. 2003;91(2):438-43. https://doi.org/10.1016/j.ygyno.2003.07.003 » https://doi.org/10.1016/j.ygyno.2003.07.003 8 Boccara D, Runz AD, Marco O, Chaouat M, Mimoun M. Primary skin umbilical endometriosis: about one case. J Clin Case Rep. 2016;6(3):100742. https://doi.org/10.4172/2165-7920.1000742 » https://doi.org/10.4172/2165-7920.1000742 9 Taniguchi F, Hirakawa E, Azuma Y, Uejima C, Ashida K, Harada T. Primary umbilical endometriosis: unusual and rare clinical presentation. Case Rep Obstet Gynecol. 2016;2016: 9302376. https://doi.org/10.1155/2016/9302376 » https://doi.org/10.1155/2016/9302376 10 Andolf E, Thorsell M, Källén K. Caesarean section and risk for endometriosis: a prospective cohort study of Swedish registries. BJOG. 2013;120(9):1061-5. https://doi.org/10.1111/1471-0528.12236 » https://doi.org/10.1111/1471-0528.12236 11 Sengul I, Sengul D, Kahyaoglu S, Kahyaoglu I. Insizyonel endometriozis: üc olguluk bir sunu. Ulusal Cerrahi Kongresi 2008 (UCK 2008), Antalya, Turkey, May 28-31, 2008. Abstract no. GEN-15, p.123. Publication Dates Publication in this collection 23 Feb 2022 Date of issue Jan 2022 History Received 30 Oct 2021 Accepted 02 Nov 2021 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. About the editors .author-card { border-bottom: 1px solid #ccc; padding: 1rem 0; } .author-card:last-child { border-bottom: 0px; } .author-name { font-weight: 600; } .orcid-button { padding-left: 2.5rem; } .modal-body { padding-bottom: 3rem; } .orcid-button::before { content: ""; position: absolute; background-image: url(https://ds.scielo.org/img/logo-orcid.svg); background-repeat: no-repeat; background-size: 1.5em auto; background-position: .5em center; display: block; width: 60px; height: 60px; top: -10px; left: 0; } person Demet Sengul * Conceptualization, Supervision, Writing – original draft, Writing – review & editing school Giresun University, School of Medicine, Department of Pathology – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Department of Pathology – Giresun, Turkey. 0000-0002-0416-0621 person Ilker Sengul Conceptualization, Writing – original draft, Writing – review & editing school Giresun University, School of Medicine, Division of Endocrine Surgery – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Division of Endocrine Surgery – Giresun, Turkey. school Giresun University, School of Medicine, Department of General Surgery – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Department of General Surgery – Giresun, Turkey. 0000-0001-5217-0755 person José Maria Soares Junior Conceptualization, Writing – editing school Universidade Federal de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia – São Paulo (SP), Brazil. Universidade Federal de São Paulo Brazil São Paulo, SP, Brazil Universidade Federal de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia – São Paulo (SP), Brazil. 0000-0003-0774-9404 person * Corresponding author: [email protected] Conflicts of interest: the authors declare there is no conflicts of interest. SCIMAGO INSTITUTIONS RANKINGS Giresun University, School of Medicine, Department of Pathology – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Department of Pathology – Giresun, Turkey. Giresun University, School of Medicine, Division of Endocrine Surgery – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Division of Endocrine Surgery – Giresun, Turkey. Giresun University, School of Medicine, Department of General Surgery – Giresun, Turkey. Giresun University Turkey Giresun, Turkey Giresun University, School of Medicine, Department of General Surgery – Giresun, Turkey. Universidade Federal de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia – São Paulo (SP), Brazil. Universidade Federal de São Paulo Brazil São Paulo, SP, Brazil Universidade Federal de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia – São Paulo (SP), Brazil. How to cite link copy function currentDate() { var today = new Date(); var months = ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] today.setTime(today.getTime()); return today.getDate() + " " + months[today.getMonth()] + " " + today.getFullYear(); } var citation = 'Sengul, Demet, Sengul, Ilker and Soares, José Maria. Caesarean section scar endometriosis:|quo vadis?. 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