Intrahepatic endometriosis as differential diagnosis: Case report and literature review

Fluegen G, Georg Fluegen, Frank Jankowiak, Jankowiak F, Luisa Zacarias Foehrding, Zacarias Foehrding L, Kroepil F, Feride Kroepil, Wolfram T Knoefel, Knoefel WT, Stefan A Topp, Topp SA
World journal of gastroenterology · 2013 · vol. 19(29) , pp. 4818 · doi:10.3748/wjg.v19.i29.4818 · PMID:23922482 · PMC3732857 · W1981112591
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This case report details a 32-year-old woman diagnosed with intrahepatic endometriosis after presenting with a progressive liver cyst, highlighting its rarity and diagnostic challenges.

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Abstract

Intrahepatic endometriosis is one of the rarest forms of atypical endometriosis; only eighteen cases have been reported in the English literature. We describe the case of a 32-year-old woman, who presented with persistent, non-cyclical upper right quadrant abdominal pain, a central liver cyst, and no history of endometriosis. Three years previous, she was diagnosed with an intrahepatic cyst. The lesion progressed and two laparoscopic deroofing-operations were performed, yet the diagnosis of intrahepatic endometriosis was never reached. She presented in our clinic with further progress of the cyst as well as obstruction of the intrahepatic biliary system. The magnetic resonance imaging showed a 9.5 cm × 12 cm, lobulated intrahepatic cyst. We performed an ultrasonic pericystectomy. Immunostaining confirmed intrahepatic endometriosis. Only one of the previously described eighteen patients with intrahepatic endometriosis presented with cyclical pain in the upper right abdominal quadrant accompanying menstruation. This lack of a "typical" clinic makes it challenging to diagnose extragonadal endometriosis without histopathology. A previous history of endometriosis was described in only twelve cases, thus the diagnosis of this condition should not be limited to patients with a known history of endometriosis. Six of 18 patients were postmenopausal, demonstrating this condition is not limited to women of reproductive age. A preoperative diagnosis was only reached in seven of the previously described cases, highlighting the importance of preoperative biopsies. Yet due to the potential adverse effects, a transhepatic biopsy must be discussed individually. Although rare, intrahepatic endometriosis should always be considered as a differential diagnosis in women with recurrent hepatic cysts, regardless of age or previous medical history. In such cases, histology is essential and a pericystectomy should be performed as standard of care.

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Condition tags

endometriosis

MeSH descriptors

Cysts Endometriosis Liver Diseases Adult Biopsy Cysts Cysts Diagnosis, Differential Endometriosis Endometriosis Female Humans Immunohistochemistry Liver Diseases Liver Diseases Magnetic Resonance Imaging Predictive Value of Tests Reoperation Tomography, X-Ray Computed Treatment Outcome

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