Case Report: Extrapelvic Endometriosis in the Medial Thigh

Erica Pascoal, Stacey Rogers, Mathew Leonardi, Nicholas Leyland
Frontiers in reproductive health · 2021 · vol. 3 · doi:10.3389/frph.2021.692249 · PMID:36303980 · PMC9580698 · W3203815342
article OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 39-year-old woman with an inner-thigh mass confirmed as endometriosis, discussing possible pathophysiologies including trauma and stem cell theory, and highlighting the role of gynecologists in management.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper is a case report of a 39-year-old nulliparous woman with a long-standing, progressively worsening tender mobile mass in the medial thigh that caused cyclic (catamenial) pain, in the context of a delayed diagnosis of a left pubic rami fracture 15 years earlier and a family history of endometriosis. The authors used pelvic MRI to characterize a thigh lesion and performed ultrasound-guided core biopsy, which confirmed endometriosis; however, they note limitations in diagnostic certainty because core biopsy has not always been conclusive in prior musculoskeletal endometriosis cases and MRI features can vary with lesion age. After incomplete early response to GnRH agonist therapy, the patient underwent extensive surgical dissection to achieve negative margins, with histology showing fibrovascular tissue containing endometriosis, and her cyclic pain resolved postoperatively after switching to dienogest despite postoperative wound complications and reduced bone density. This paper is centrally about endometriosis — specifically extrapelvic musculoskeletal (medial thigh) endometriosis following pelvic fracture.

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Abstract

Extrapelvic endometriosis, although rare, can present in the musculoskeletal system of reproductive-age women and cause significant pain and morbidity. The pathophysiology of this disease is not well understood. In this study, we described the case of a 39-year-old women with an inner-thigh mass causing catamenial pain. Core-biopsy of the mass confirmed endometriosis and she was referred to minimally-invasive gynecology for management. Surgical excision was performed by a multidisciplinary team and she remains pain-free postoperatively on hormonal therapy. Unique to this case, the patient had a history of pelvic fracture. Through this case report, we discuss possible pathophysiologic mechanisms of extrapelvic musculoskeletal endometriosis including the stem/progenitor cell theory and the role that musculoskeletal trauma may have in the development of this condition. Gynecologists play an important role in the recognition, diagnosis, and management of musculoskeletal endometriosis.

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Condition tags

endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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