Isolated Abdominal Wall Endometriosis Presenting as an Anterior Abdominal Mass: Histopathological Confirmation

A 35‐year‐old woman presented with a previous history of hysterectomy 5 years ago with a gradually enlarging, painful swelling over the anterior abdominal wall, associated with nausea and vomiting. On examination, a firm localized mass was palpated in the right anterior abdominal wall, just below the umbilicus. Ultrasound revealed a well‐defined hypoechoic lesion beneath the umbilicus, measuring approximately 26 × 14 mm. Surgical excision revealed an abdominal wall mass (Figure  1A ), while the ovaries appeared grossly unremarkable (Figure  1C ). Histopathology of the excised mass demonstrated endometrial glands and stroma infiltrating skeletal muscle fibers, confirming endometriosis (Figure  1B ). This uncommon occurrence of abdominal wall endometrioma within a cesarean section scar posed a diagnostic challenge both clinically and with diagnostic imaging. In contrast, ovarian histology showed normal cystic follicles and stroma without endometriotic deposits (Figure  1D ). (A) Gross specimen of anterior abdominal wall mass showing endometriotic tissue. (B) Histological Section of anterior abdominal wall mass showing endometrial glands and stroma infiltrating skeletal muscle fibers (H&E stain). (C) Gross specimen of ovary without the evidence of endometriosis. (D) Histological section of normal ovary demonstrating cystic follicles and stroma without evidence of endometriosis (H&E stain).

Muhammad Umar Ahsan: conceptualization, data curation, investigation, writing – original draft, writing – review and editing. Saba Shaheen: conceptualization, investigation, writing – original draft, writing – review and editing. Muhammad Mudasir: writing – original draft, writing – review and editing. Nadia Qadir: writing – original draft, writing – review and editing. Somaiya Ahmed: writing – original draft, writing – review and editing.

The paper is exempt from ethical committee approval because of the single case study.

The authors have nothing to report.

Endometriosis is defined as the presence of endometrial‐like epithelium and/or stroma outside the uterine cavity. It is a common, benign, chronic inflammatory disease affecting approximately 10% of women of reproductive age. Clinically, AWE might resemble an abscess, suture granuloma, hematoma, desmoid tumor, sarcoma, lipoma, and metastatic cancer. Previous pelvic surgery is recognized as a potential risk factor for abdominal wall endometriosis (AWE). The prevalence of abdominal wall endometriosis is 0.03%–1.08% in women with a history of obstetric or gynecological procedures. Some of the patients with endometriosis may present with pain while others do not have any significant symptoms; that's why postoperative histological examinations remain the gold standard as they can make the thorough diagnosis and exclude malignancy. AWE can be treated both medicinally and surgically, with the surgical intervention being the most definitive and commonly used as it relieves the symptoms completely. Oral contraceptives, gonadotropin‐releasing hormone analogues, aromatase inhibitors, and dienogest are the mainstays of medical treatment. In order to prevent recurrence, this treatment can be helpful in conjunction with surgical excision. Non‐steroidal anti‐inflammatory drugs are advised to alleviate discomfort associated with the placement of endometriosis on the abdominal wall and to make surgical removal easier by reducing inflammation surrounding the lesions. Surgical excision with clear margins remains the treatment of choice, offering both definitive diagnosis and symptomatic relief [ 1 , 2 , 3 ].

The informed consent was taken in written form from the patient. She gave us consent for her photographs and medical information to be published in print and online with the understanding that this information is publicly available.

The authors declare no conflicts of interest.