Clinical management and immunohistochemical analysis of umbilical endometriosis

Sylvia Mechsner, Julia Bartley, Bartley J, Infanger M, Manfred Infanger, Loddenkemper C, Christoph Loddenkemper, Johanna Herbel, Herbel J, Andreas D. Ebert, Ebert AD
Archives of gynecology and obstetrics · 2008 · vol. 280(2) , pp. 235–242 · doi:10.1007/s00404-008-0900-4 · PMID:19116726 · W2080519940
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-28 ⓘ

This case report describes the diagnostic and therapeutic management of umbilical endometriosis, with immunohistochemical analysis revealing CD10, estrogen/progestogen receptors, smooth muscle metaplasia, and angiogenesis.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper reports the clinical diagnostic workup, surgical management, and immunohistochemical characterization of a 42-year-old woman with umbilical endometriosis, using clinical examination, vaginal/abdominal ultrasound, MRI, laparoscopy, and subsequent umbilical reconstruction. The lesion was extensive enough to require total removal of the umbilicus, and the immunohistochemical profile showed CD10 expression, estrogen and progesterone receptors, moderate proliferation, and evidence of metaplastic/angiogenic features including smooth muscle metaplasia and angiogenesis, with positivity for smooth muscle markers (smooth muscle actin, caldesmon, desmin), COX-2, and VEGF. The explicit limitation is that the findings are based on a single case (with reference to literature review) rather than a larger cohort. This paper is centrally about endometriosis — it focuses specifically on diagnostic/therapeutic management and tissue biology of umbilical endometriosis.

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Abstract

PurposeTo established a strategy for diagnostic and therapeutic management of umbilical endometriosis and to determine the biological character.MethodsClinical examination, vaginal and abdominal ultrasound, magnetic resonance imaging of the abdominal wall and laparoscopy were performed on a 42-year-old woman with umbilical endometriosis. Surgery with umbilical reconstruction was performed by a new plastic surgery technique. Immunohistochemical analyses (against Ki 67, estrogen/progestogen receptor, CD10, smooth muscle actin, desmin, caldesmon, von Willebrandt factor, cyclooxygensae-2 and VEGF) were done to characterize the umbilical endometriotic lesion.ResultsThe extension of the endometriotic lesion necessitated total removal of the umbilicus. Umbilical reconstruction was performed by a new plastic surgery technique. The lesion did express CD10, estrogen and progestogen receptors, and did show a moderate proliferation rate. Furthermore, signs of metaplastic processes such as smooth muscle metaplasia and angiogenesis were detected. The endometriotic lesion was positive not only for smooth muscle actin, caldesmon and desmin, but also for COX-2 and VEGF.ConclusionBased on a case report and a literature review, we discuss the diagnostic and therapeutic management of umbilical endometriosis at our endometriosis research center. Furthermore, our data suggest that the umbilical endometriotic lesion originated from reactivated multipotent cells.
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Abstract

Purpose To established a strategy for diagnostic and therapeutic management of umbilical endometriosis and to determine the biological character.

Methods

Clinical examination, vaginal and abdominal ultrasound, magnetic resonance imaging of the abdominal wall and laparoscopy were performed on a 42-year-old woman with umbilical endometriosis. Surgery with umbilical reconstruction was performed by a new plastic surgery technique. Immunohistochemical analyses (against Ki 67, estrogen/progestogen receptor, CD10, smooth muscle actin, desmin, caldesmon, von Willebrandt factor, cyclooxygensae-2 and VEGF) were done to characterize the umbilical endometriotic lesion.

Results

The extension of the endometriotic lesion necessitated total removal of the umbilicus. Umbilical reconstruction was performed by a new plastic surgery technique. The lesion did express CD10, estrogen and progestogen receptors, and did show a moderate proliferation rate. Furthermore, signs of metaplastic processes such as smooth muscle metaplasia and angiogenesis were detected. The endometriotic lesion was positive not only for smooth muscle actin, caldesmon and desmin, but also for COX-2 and VEGF.

Conclusion

Based on a case report and a literature review, we discuss the diagnostic and therapeutic management of umbilical endometriosis at our endometriosis research center. Furthermore, our data suggest that the umbilical endometriotic lesion originated from reactivated multipotent cells. Similar content being viewed by others

References

Latcher JW (1953) Endometriosis of the umbilicus. Am J Obstet Gynecol 66:161–168 Michowitz M, Baratz M, Stavorovsky M (1983) Endometriosis of the umbilicus. Dermatologica 167:326–330 Singh KLAM, Adam DJ et al (1995) Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg 82:1349–1351. doi:10.1002/bjs.1800821017 Frischknecht F, Raio L, Fleischmann A et al (2004) Umbilical endometriosis. Surg Endosc 18:347. doi:10.1007/s00464-003-4245-6 Purvis RS, Tyring SK (1994) Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. J Dermatol Surg Oncol 20:693–695 Daoudi K, Bongain A, Isnard V et al. (1995) Umbilical endometriosis. A case report. Rev Fr Gynecol Obstet 90:442–443 von Stemm AM, Meigel WN, Scheidel P et al (1999) Umbilical endometriosis. J Eur Acad Dermatol Venereol 12:30–32. doi:10.1016/S0926-9959(98)00099-3 Igberase GO, Igbekoyi OF (2005) Umbilical endometriosis in a 45 year old Nigerian grandmultipara. Afr J Med Med Sci 34:193–194 Sidani MS, Khalil AM, Tawil AN et al (2002) Primary umbilical endometriosis. Clin Exp Obstet Gynecol 29:40–41 Bartsich S, Schwartz M (2002) Purse-String method for immediate umbilical reconstruction. Plast Reconstr Surg 112:1652–1655 Kokuba EM, Sabino NM, Sato H et al (2006) Reconstruction technique for umbilical endometriosis. Int J Gynaecol Obstet 94:37–40. doi:10.1016/j.ijgo.2006.04.034 Meyer R (1930) Adenofibrosis und Adenomyosis am Nabel. In: Handbuch der Gynäkologie, vol 3. von Stöckel, Berlin, pp 511–515 Roncoroni LCR, Violi V, Nunziata R (2001) Endometriosis on laparotomy scar. A three-case report. Arch Gynecol Obstet 265:165–167. doi:10.1007/s004040000153 Scott RT RW (1958) External endometriosis-the scourge of the private patient. Ann Surg 13:697–720 Steck WHEB (1966) Cutaneus endometriosis. Clin Obstet Gynecol 9:373–383. doi:10.1097/00003081-196606000-00007 Mechsner S, Bartley J, Loddenkemper C et al (2005) Oxytocin receptor expression in smooth muscle cells of peritoneal endometriotic lesions and ovarian endometriotic cysts. Fertil Steril 83(Suppl 1):1220–1231. doi:10.1016/j.fertnstert.2004.11.038 Hasegawa T, Hasegawa F, Hirose T et al (2003) Expression of smooth muscle markers in so called malignant fibrous histiocytomas. J Clin Pathol 56:666–671. doi:10.1136/jcp.56.9.666 Taylor R, Lebovic DI, Mueller MD (2002) Angiogenic factors in endometriosis. NY Acad Sci 955:89–100 Conflict of interest statement None. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Mechsner, S., Bartley, J., Infanger, M. et al. Clinical management and immunohistochemical analysis of umbilical endometriosis. Arch Gynecol Obstet 280, 235–242 (2009). https://doi.org/10.1007/s00404-008-0900-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-008-0900-4

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Umbilicus Adult Endometriosis Endometriosis Female Humans Immunohistochemistry Laparoscopy Middle Aged Umbilicus

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