Clinical analysis of 101 cases of abdominal wall endometriosis

Objective: To investigate the clinical characteristics,treatments and prognoses of abdominal wall endometriosis.Methods: A retrospective analysis was performed on 101 patients with abdominal wall endometriosis(AWE) hospitalized in Obstetric Gynecologic Department of Peking Union Medical College Hospital between 1992 and 2005.Results: Of 101 patients with AWE,98 had a history of caesarean section,with an abdominal wall mass(average 1.5 cm) at the first visit.Their mean age was(33.3±4.8) years.89.8% of patients had a menses-related cyclically painful mass.The incidence of abdominal wall endometriosis in the patients undergoing caesarean delivery in our hospital was 0.05%.Among 8,061 patients with endometriosis of pelvis treated by surgery,no AWE case was observed.CA12535 U/ml was recorded in 20.5% of patients.AWE was diagnosed before surgery in 92.1% of patients.Pre-operational medication was adopted in 16 cases,and 14 patients received medication after surgery.The mean size of the lesions resected in the surgeries was 4.2 cm,significantly larger than that measured by pre-operational palpation or ultrasonography(about 0.8～1.2 cm)(P0.01).Ten patients relapsed after surgery,and 5 of them received resection after relapse.Atypical endometriosis was pathologically confirmed in 1 patient.This patient relapsed after surgery and was finally diagnosed as sarcomatous transformation.Conclusions: B-ultrasonography can be used to measure the size of mass and define the infiltrative extent.The pre-surgical serum CA125 evaluation was not sensitive enough for the diagnosis and could not be used to predict the relapse.Surgical excision of AWE with at least 1 cm outside the edge of AWE,combined with pre-surgical and post-surgical medication,should be the first choice.Repeated resection can be considered in recurrent patients.Possibility of malignant transformation of AWE should be considered in the patients with repeatedly relapse.