Hasfali endometriosis: differenciáldiagnosztikai nehézségek a radiológus szemszögéből = Differential diagnostic challenges of abdominal wall endometriosis from the radiologist’s point of view

Absztrakt: Az endometriosissal kuzdő betegek szama, ezen belul az atipusos megjelenesi formak előfordulasa is folyamatosan novekszik, ez pedig a kepalkoto diagnosztat is novekvő kihivas es fejlődes ele allitja. Retrospektiv modon a 2016 es 2018 kozotti, női paciensek eseteben vegzett ultrahangvezerelt intervencios vizsgalatokat tekintettuk at, melyek ismeretlen dignitasu hasfali terime miatt tortentek a Szegedi Tudomanyegyetemmel egyuttműkodő diagnosztikai kozpontjainkban. A hasfali elteresek kozul egyet CT-, a tobbit ultrahangvizsgalat soran eszleltuk mellekleletkent. Osszesen 12 eset felelt meg a bevalogatasi felteteleknek. A betegek atlageletkora 59 ev (29–79 ev), az elteresek atlagos merete 34,4 mm (20–49 mm) volt; az anamnezisben hasfali műtet 8 esetben szerepelt. A kivizsgalas indikacioja minden esetben malignus folyamat vagy annak gyanuja volt, a mintavetelt 4 esetben MRI-vizsgalat előzte meg. Ezeken kivul tovabbi 2 esetben a hasfali keplet exciziojat nem előzte meg ultrahangvezerelt mintavetel, az endometriosis diagnozisat az eltavolitott keplet patologiai vizsgalataval allitottuk fel. Egy esetben a szovettani diagnozis primer, serosus tipusu epithelialis malignus tumort, hat esetben metasztazist, hat esetben endometriosist, egy esetben pedig hasfali talyogot igazolt. Az endometriosis a fiatalabb korosztalyban fordult elő. Fiatal, praemenopausaban levő nőbetegek hasfali kepletenek eseteiben az endometriosis valoszinűsege kifejezetten nagy, főkent, ha az anamnezisben szuleszeti vagy nőgyogyaszati műtet is szerepel. Az elvaltozas felismereseben, illetve a kesőbbi sebeszi kezeles megtervezeseben az ultrahangvizsgalatnak elsődleges szerepe van. Orv Hetil. 2019; 160(35): 1395–1402. | Abstract: The incidence of endometriosis, including atypical forms of the disease, has been continuously growing, thus increasingly challenging for the imaging specialists as well. We conducted a retrospective study to analyze the results of ultrasound-guided interventions between 2016 and 2018. All interventions were performed in female patients due to uncertain abdominal wall lesions at the University of Szeged, Hungary. The abdominal wall lesions were incidentally detected, one by CT, the others by ultrasound examinations. We identified 12 cases during the study period. The average age of the patients was 59 years (29–79), 8 of them had abdominal surgery in their medical history. The mean diameter of the masses was 34.4 mm (20–49 mm). Since the indication of imaging examinations was the evaluation of a known or suspected malignancy, four patients had undergone an MRI prior to the biopsy. In addition, ultrasound-guided biopsy was not performed in another two patients, and the diagnosis was established by histological examination of the surgically removed specimens. The histological examination revealed malignant primary serous epithelial tumor in one case, metastases in six cases, endometriosis in six patients and abdominal wall abscess was found in one patient. Endometriosis was more frequent in the younger patients. The likelihood of endometriosis as a cause of abdominal wall lesions of younger, premenopausal female patients is rather high, especially with obstetrical or gynaecological operations in the medical history. Ultrasound plays a primary role in the detection and therapy planning of these lesions. Orv Hetil. 2019; 160(35): 1395–1403.