The ultrasound of subcutaneous extrapelvic endometriosis

Ashraf Talaat Youssef, Youssef AT
Journal of ultrasonography · 2020 · vol. 20(82) , pp. 176–180 · doi:10.15557/jou.2020.0029 · PMID:33365153 · PMC7705481 · W3109839198
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This study evaluated 24 patients with extrapelvic endometriosis, finding ultrasound to be a useful diagnostic tool for assessing lesions in the abdominal wall, perineum, and umbilicus.

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This study evaluated 24 women with extrapelvic endometriomas using clinical examination, serum CA 125 measurement, and ultrasound approaches tailored to suspected ectopic sites (abdominal wall/cesarean scar or umbilicus, transperineal for perianal lesions, and transvaginal ultrasound to rule out ovarian endometriosis or uterine adenomyosis). Surgical findings and histopathology of excised specimens established the final diagnoses. The authors detected cesarean section scar endometrioma in 19 patients, perianal endometriomas in 3, and umbilical endometriomas in 2, concluding that ultrasound was useful for assessing extrapelvic endometriosis and its extension, particularly when typical clinical features are absent and serum CA 125 has low diagnostic sensitivity. This paper is centrally about endometriosis — it focuses specifically on the ultrasound diagnosis of subcutaneous extrapelvic endometriosis at uncommon sites.

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Abstract

Background: The presence of ectopic functional endometrial glands and struma anywhere except in the lining of the uterine cavity is considered as endometriosis. Extrapelvic endometriosis involving the abdominal wall cesarean section scar is uncommonly seen, and it rarely involves the perineum, umbilicus, pleura, kidneys, lungs and liver. Objectives: The purpose of the present study is to highlight rare ectopic sites, explain the pathogenesis of extrapelvic endometriosis, and evaluate the diagnostic significance of clinical findings, serum CA 125 level, and ultrasonography. Materials and methods: 24 female patients with extrapelvic endometriomas in whom the final diagnosis was based on the surgical results and histopathological reports of the excised specimens. The patients underwent a clinical examination, an ultrasound scan, and evaluation of the serum CA 125 level. They were also examined by transvaginal ultrasound to rule out ovarian endometriosis or uterine adenomyosis. They were further subjected to abdominal wall ultrasound in cases of cesarean section scar or umbilical region swellings, and transperineal ultrasound for perianal lesions. Transvaginal ultrasound was performed in patients with perineal endometrioma to assess the relation between the lesion and the external anal sphincter. Results: In 19 patients, abdominal wall cesarean section scar endometrioma was detected. Three patients had perianal endometriomas, and two patients – umbilical endometriomas. Conclusion: Ultrasound scanning was a useful diagnostic tool to evaluate extrapelvic endometriosis and its extension, especially in cases without typical clinical features that can be suggestive of endometrioma, low diagnostic sensitivity of serum CA 125, and low incidence of concomitant intrapelvic disease.
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The ultrasound of subcutaneous extrapelvic endometriosis Ashraf Talaat Youssef Background: The presence of ectopic functional endometrial glands and struma anywhere except in the lining of the uterine cavity is considered as endometriosis. Extrapelvic endometriosis involving the abdominal wall cesarean section scar is uncommonly seen, and it rarely involves the perineum, umbilicus, pleura, kidneys, lungs and liver. Objectives: The purpose of the present study is to highlight rare ectopic sites, explain the pathogenesis of extrapelvic endometriosis, and evaluate the diagnostic significance of clinical findings, serum CA 125 level, and ultrasonography. Materials and methods: 24 female patients with extrapelvic endometriomas in whom the final diagnosis was based on the surgical results and histopathological reports of the excised specimens. The patients underwent a clinical examination, an ultrasound scan, and evaluation of the serum CA 125 level. They were also examined by transvaginal ultrasound to rule out ovarian endometriosis or uterine adenomyosis. They were further subjected to abdominal wall ultrasound in cases of cesarean section scar or umbilical region swellings, and transperineal ultrasound for perianal lesions. Transvaginal ultrasound was performed in patients with perineal endometrioma to assess the relation between the lesion and the external anal sphincter. Results: In 19 patients, abdominal wall cesarean section scar endometrioma was detected. Three patients had perianal endometriomas, and two patients – umbilical endometriomas. Conclusion: Ultrasound scanning was a useful diagnostic tool to evaluate extrapelvic endometriosis and its extension, especially in cases without typical clinical features that can be suggestive of endometrioma, low diagnostic sensitivity of serum CA 125, and low incidence of concomitant intrapelvic disease.

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endometriosisadenomyosisendometrioma

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