Deep Perineal Endometriosis in an Episiotomy scar with IHC findings

Perineal endometriosis (PE) is a rare entity which can be explained by direct implantation of endometriotic cells over episiotomy wound and subsequent development of scar endometriosis. Present patient presented with current pain in her perineal swelling at episiotomy scar which was associated with menstruation. First-line simple procedure of FNAC detected endometrial cells and stromal fragments from scar tissue. Therapeutic wide local excision (WLE) was done and sent for histopathological examination (HPE). HPE and Immunohistochemistry (IHC) confirmed it as PE, staining the endometrial glands and endometrial stromal component in scar tissue. The post-surgical stay was uneventful. Patient was followed up after six months with no signs/ symptoms of recurrence.