Abdominal Wall Endometrioma: Case Report

Hakan Mersin, Gökçe Acun, Uğur Berberoğlu
2015 · W2564633009
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This case report describes a 36-year-old woman presenting with pain and a palpable mass in the left lower quadrant of her abdomen, four years after undergoing a cesarean section. Imaging revealed a small hypoechoic nodule with calcifications, but fine-needle aspiration biopsy failed to provide a definitive diagnosis, necessitating surgical excision for confirmation. Histopathological examination of the resected tissue from the rectus abdominis muscle confirmed the lesion as an endometrioma, highlighting that prior gynecological surgery should raise suspicion for this condition in patients with abdominal wall masses. This paper is centrally about endometriosis — specifically the presentation and management of abdominal wall endometrioma following cesarean delivery.

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Abstract

Abdominal wall endometriosis is a vvell-circumscribed mass composed of endometrial gland and stroma which may develop after a gynecologic surgery such as a cesarean section, at the scar of incisions. Since they usually appear as a mass at the inci-sion area which can be mistaken for incisional hernia, patients submit to general surgeons. Correct pre-operative diagnosis is difficult. In the light of current literature, we would tike to discuss the diagnosis and treatment planning of abdominal wall endometriosis, which is a rare lesion, by means of a case treated in our clinic. A 36-years-oid female patient who underwent a cesarean section four years ago presented vvith ongoing abdominal pain and mass at the left lovver quadrant since last year. Superficial ultrasonography showed a 14 mm x 12 mm hypoechoic nodular lesion vvith calcifications. Approximately 1 cm dia-meter nodular soft tissue was detected at computerized tomography. Fine needle aspiration biopsy was not diagnostic so exci-sional surgery was planned. The lesion in the left rectus abdominis muscle which was 2 cm in diameter was excised vvith safe margins. Histopathological report was endometrioma. As a result, history of previous gynecologic surgery especially cesarean section and periodic pain during the menses in woman patients vvith abdominal pain and abdominal vvall mass should raise sus-picion of endometrioma.
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EN TR Abdominal Wall Endometrioma: Case Report Öz Karın duvarı endometriyomaları, başta sezaryen olmak üzere histerotomi yapılan jinekolojik girişimlerden sonra insizyon veya skar dokusunda gelişebilen, endometriyum bez ve stromasından oluşan bir kitledir. Genellikle insizyon bölgesinde yerleşen bir kitleye neden oldukları için sıklıkla insizyonel fıtıkla karışır ve hastalar genellikle genel cerrahlara başvurur. Ameliyat öncesi tanı konulması zordur. Nadir bir lezyon olan karın duvarı endometriyomasının tanı ve tedavi planını, güncel literatür ışığında tartışmak üzere tedavi ettiğimiz bir olgumuzu sunmak istiyoruz. Dört yıl önce sezaryen ameliyatı geçiren 36 yaşındaki kadın hasta son bir yıldır, karın sol alt kadranda ağrı ve kitle yakınması ile başvurdu. Yüzeyel ultrasonografide 14 mm x 12 mm boyutlarında, içerisinde kalsifikasyonlar bulunan hipoekoik nodüler lezyon, bilgisayarlı tomografide yaklaşık 1 cm çapında nodüler yumuşak doku izlendi. Kitleden yapılan ince iğne aspirasyon biyopsisi ile tanı konulamayan hasta eksizyon planlanarak ameliyata alındı. Sol rektus abdominis kası içinde, kasın kılıfını da tutan yaklaşık 2 cm çapındaki kitle, etrafındaki sağlam doku sınırlarından eksize edildi. Histopatolojik inceleme sonucu endometriyoma olarak rapor edildi. Sonuç olarak, karın ağrısı ile birlikte karın duvarında kitle olan kadın hastalarda, periyodik ağrı ve başta sezaryen olmak üzere geçirilmiş jinekolojik ameliyat öyküsü olması endometriyoma olasılığını akla getirmelidir. Anahtar Kelimeler Kaynakça - Horton JD, DeZee KJ, Ahnfeldt EP, VVagrıer M. Abdominal wall endometriosis: A surgeon’s perspective and review of 445 cases. Am J Surgery 2008;196:207-12. - Blanco RG, Parithivel l/S, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg 2003; 85:596-8. - Seli E, Berkkanogiu M, Arici A. Pathogenesis of endomet riosis. Obstet Gynecol d in North Am 2003;30:41-61. - Nirula R, Greaney GC. Incisional endometriosis: An unde- rappreciated diagnosis in general surgery. J Am Coll Surg 2000;190:404-7. - Şimşir A, ThornerK, VVaismanJ, CangiarellaJ. Endometriosis - in abdominal scars: A report of three cases diagnosed by fine- needie aspiration biopsy. Am Surg 2001;67:984-6. - Madsen H, Hansen P, Andersen OP. Endometrioid carcino- ma in an operation scar. Ada Obstet Gynecol Scand 1980;59:475-6. - Chene G, Darcha C, Dechelotte P, Mage G, Canis M. Malignant degeneration of perineal endometriosis in episio- tomy scar, case report and review of the literatüre. Int J Gynecol Cancer 2007;17:709-14. Ayrıntılar Birincil Dil Türkçe Konular - Bölüm - Yayımlanma Tarihi 1 Aralık 2009 Gönderilme Tarihi 26 Aralık 2015 Kabul Tarihi - Yayımlandığı Sayı Yıl 2009 Cilt: 42 Sayı: 3 APA Mersin, H. H., Acun, G., & Berberoğlu, U. (2009). Abdominal Wall Endometrioma: Case Report. Acta Oncologica Turcica, 42(3), 118-120. https://izlik.org/JA54RU24XG AMA 1.Mersin HH, Acun G, Berberoğlu U. Abdominal Wall Endometrioma: Case Report. Acta Oncologica Turcica. 2009;42(3):118-120. https://izlik.org/JA54RU24XG Chicago Mersin, H. Hakan, Gökçe Acun, ve Uğur Berberoğlu. 2009. “Abdominal Wall Endometrioma: Case Report”. Acta Oncologica Turcica 42 (3): 118-20. https://izlik.org/JA54RU24XG. EndNote Mersin HH, Acun G, Berberoğlu U (01 Aralık 2009) Abdominal Wall Endometrioma: Case Report. Acta Oncologica Turcica 42 3 118–120. IEEE [1]H. H. Mersin, G. Acun, ve U. Berberoğlu, “Abdominal Wall Endometrioma: Case Report”, Acta Oncologica Turcica, c. 42, sy 3, ss. 118–120, Ara. 2009, [çevrimiçi]. Erişim adresi: https://izlik.org/JA54RU24XG ISNAD Mersin, H. Hakan - Acun, Gökçe - Berberoğlu, Uğur. “Abdominal Wall Endometrioma: Case Report”. Acta Oncologica Turcica 42/3 (01 Aralık 2009): 118-120. https://izlik.org/JA54RU24XG. JAMA 1.Mersin HH, Acun G, Berberoğlu U. Abdominal Wall Endometrioma: Case Report. Acta Oncologica Turcica. 2009;42:118–120. MLA Mersin, H. Hakan, vd. “Abdominal Wall Endometrioma: Case Report”. Acta Oncologica Turcica, c. 42, sy 3, Aralık 2009, ss. 118-20, https://izlik.org/JA54RU24XG. Vancouver 1.H. Hakan Mersin, Gökçe Acun, Uğur Berberoğlu. Abdominal Wall Endometrioma: Case Report. Acta Oncologica Turcica [Internet]. 01 Aralık 2009;42(3):118-20. Erişim adresi: https://izlik.org/JA54RU24XG

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