Fine needle aspiration cytology diagnosis of caesarean scar endometriosis with histopathological correlation: a case report

Sandeep Kumar, Varuna Mallya, Krishna Kishor
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2015 · pp. 921–923 · doi:10.18203/2320-1770.ijrcog20150130 · W589684332
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Fine needle aspiration cytology accurately diagnosed caesarean scar endometriosis in a 25-year-old woman, with histopathological confirmation supporting its value as an economical and fast diagnostic method for this rare condition.

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This case report describes the diagnosis of a 25-year-old woman presenting with a painful mass in her anterior abdominal wall located at a previous caesarean section scar. The authors utilized fine needle aspiration cytology to identify monolayered sheets of endometrial cells, spindle-shaped stromal cells, and hemosiderin-laden macrophages, findings that were subsequently confirmed by histopathological examination. The study highlights that while incisional endometriosis is rare, it should be considered in the differential diagnosis of painful abdominal masses in women, noting that FNAC offers an economical and accurate diagnostic method. This paper is centrally about endometriosis — specifically the cytological diagnosis of caesarean scar endometriosis.

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Abstract

Endometriosis is defined as the presence of endometrial tissue outside the endometrium or myometrium. It occurs in 8-15% of women of reproductive age group with abdominal wall endometriosis accounting for only 0.5-1% of all pelvic endometriosis. We present a case of a 25 year old lady who presented with a mass in the anterior abdominal wall over a previous caesarean section scar. Endometriosis was diagnosed on Fine Needle Aspiration Cytology (FNAC) based on the findings of monolayered sheets of endometrial cells, few spindle shaped stromal cells and hemosiderin laden macrophages in the background. Histopathological examination confirmed the cytological diagnosis. Endometriosis in scar tissue is a rare disease which might be difficult to diagnose and should always be considered in evaluation of painful abdominal masses in women. Fine needle aspiration cytology is economical, fast and accurate method to make the diagnosis of scar endometriosis and to plan better surgical approach.
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Fine needle aspiration cytology diagnosis of caesarean scar endometriosis with histopathological correlation: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20150130Keywords: Caesarean scar endometriosis, Fine needle aspiration cytology, EndometriosisAbstract Endometriosis is defined as the presence of endometrial tissue outside the endometrium or myometrium. It occurs in 8-15% of women of reproductive age group with abdominal wall endometriosis accounting for only 0.5-1% of all pelvic endometriosis. We present a case of a 25 year old lady who presented with a mass in the anterior abdominal wall over a previous caesarean section scar. Endometriosis was diagnosed on Fine Needle Aspiration Cytology (FNAC) based on the findings of monolayered sheets of endometrial cells, few spindle shaped stromal cells and hemosiderin laden macrophages in the background. Histopathological examination confirmed the cytological diagnosis. Endometriosis in scar tissue is a rare disease which might be difficult to diagnose and should always be considered in evaluation of painful abdominal masses in women. Fine needle aspiration cytology is economical, fast and accurate method to make the diagnosis of scar endometriosis and to plan better surgical approach.Metrics References Philip BC, Robert HY. The peritoneum. In: Stacey EM, Daryll C, Joel KG, Victor ER, Mark HS, eds. Sternberg’s Diagnostic Surgical Pathology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2010: 2392-2418. Sengul I, Sengul D, Kahyaoglu S, Kahyaoglu I. Incisional endometriosis: a report of 3 cases. Can J Surg. 2009;52(5):444-5. Veda P, Srinivasaiah M. Incisional endometriosis: Diagnosed by fine needle aspiration cytology. J Lab Physicians. 2010;2:117-20. Agarwal N, Subramanian A. Endometriosis - morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2(1):1-9. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185:596-8. Pathan SK, Kapila K, Haji BE, Mallik MK, Al-Ansary TA, George SS, et al. Cytomorphological spectrum in scar endometriosis: a study of eight cases. Cytopathology. 2005;16:94-9. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg. 2008;196:207-12. Mahesh KU, Anil KS, Jaya M. Cytological diagnosis of abdominal scar endometriosis. Asian J Med Clin Sci. 2012;1:47-8. Giampiero F, Cristiano G, Giovanni A, Stefano C, Raffaele F, Giampado T. Abdominal wall endometriomas near cesarean delivery scars: sonographic and color Doppler findings in a series of 12 patients. J Ultrasound Med. 2003;22:1041-7. Teng CC, Yang HM, Chen KF, Yang CJ, Chen LS, Kuo CL. Abdominal wall endometriosis: an overlooked but possibly preventable complication. Taiwan J Obstet Gynecol. 2008;47:42-8.

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