Extra-pelvic endometriosis presenting as recurrent hepatic cyst: case report and literature review

Ruqia Mushtaq, Aqsa Ameer, Muhammad Hanif, Fatima Rauf
In: International Surgery Journal · 2021 · vol. 8(8) , pp. 2436 · doi:10.18203/2349-2902.isj20213143 · W4206311481
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This case report describes a 30-year-old female with hepatic endometriosis presenting as a recurrent hepatic cyst, highlighting the importance of considering endometriosis in the differential diagnosis of liver lesions in women.

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This paper reports a 30-year-old multiparous woman with fever and right hypochondrial pain, whose imaging suggested a cystic liver lesion that was laparoscopically managed as a presumed hepatic cyst. Histopathology and immunohistochemistry supported endometriosis, adding the 43rd published case of hepatic endometriosis (extra-pelvic endometriosis) to the literature, and the authors emphasize that imaging can be variable and definitive diagnosis requires histologic/immunohistochemical evidence. A key limitation is that, as a single case report with literature review, the findings cannot establish diagnostic accuracy beyond illustrating the diagnostic challenge. This paper is centrally about endometriosis — it specifically addresses extra-pelvic hepatic (liver) endometriosis presenting as a recurrent hepatic cyst.

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Abstract

Hepatic endometriosis is a very rare form of endometriosis first described by Rokitansky in 1986. To our knowledge, 42 cases of hepatic endometriosis have been reported in the literature till date. The condition offers a diagnostic challenge owing to its variable presentation on imaging and the need for histological and immunohistochemical evidence for a definite diagnosis. We hereby present the 43rd case of ectopic endometrium in the liver of a 30 years old, multiparous female who presented with fever and pain in the right hypochondrium. Radiological imaging suggested a cystic lesion which was managed laparoscopically. Histopathology and immunohistochemistry findings came out to be consistent with endometriosis. The case highlighted the importance of considering endometriosis as a differential in all women irrespective of age and previous history of endometriosis.
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Extra-pelvic endometriosis presenting as recurrent hepatic cyst: case report and literature review DOI: https://doi.org/10.18203/2349-2902.isj20213143Keywords: Endometriosis, Cyst, Hepatic endometriosis, Liver endometriosis, Case reportAbstract Hepatic endometriosis is a very rare form of endometriosis first described by Rokitansky in 1986. To our knowledge, 42 cases of hepatic endometriosis have been reported in the literature till date. The condition offers a diagnostic challenge owing to its variable presentation on imaging and the need for histological and immunohistochemical evidence for a definite diagnosis. We hereby present the 43rd case of ectopic endometrium in the liver of a 30 years old, multiparous female who presented with fever and pain in the right hypochondrium. Radiological imaging suggested a cystic lesion which was managed laparoscopically. Histopathology and immunohistochemistry findings came out to be consistent with endometriosis. The case highlighted the importance of considering endometriosis as a differential in all women irrespective of age and previous history of endometriosis. Metrics References Charatsi D, Koukoura O, Ntavela IG, Chintziou F, Gkorila G, Tsagkoulis M, et al. Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extra-pelvic Endometriosis. Advan Med. 2018;3461209. Markham SM. In: Modern Approaches to Endometriosis. Thomas EJ, Rock JA, eds. Extra-pelvic endometriosis. Dordrecht: Springer; 1991. Bohra AK, Diamond T. Endometrioma of the liver. International journal of clinical practice. Mohling S. Hepatic Endometriosis. J Minimally Invasive Gynecol. 2001;55(4):286-7. Mohling S. Hepatic Endometriosis. Journal of Minimally Invasive Gynecology. 2020;27(7):31. Baniak N, Adams S, Chibbar R, Lee CH, Kanthan R. Hepatic endometrial stromal sarcoma. Pathol Res Practice. 2018;214(10):1726-31. Khan AW, Craig M, Jarmulowicz M, Davidson BR. 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