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Primary umbilical endometriosis. Case report and discussion on management options.

Fancellu A, Pinna A, Manca A, Capobianco G, Porcu A - Int J Surg Case Rep (2013)

Bottom Line: Neither symptoms nor signs of local recurrence have been observed after 24 months.The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100 Sassari, Italy. Electronic address: afancel@uniss.it.

No MeSH data available.


Related in: MedlinePlus

(A) Morphologic features of endometriosis. Endometrial stroma and glands embedded in dense fibroconnectival tissue. H&E stain: 400×. (B) Immunohistochemistry for CD10 showing strong cytoplasmic positivity in stromal cells. 400×. (C) Immunohistochemistry for estrogen receptors showing nuclear positivity in both epithelial and stromal cells. 400×. (D) Immunohistochemistry for progesterone receptors showing nuclear positivity in both epithelial and stromal cells. 400×.
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fig0015: (A) Morphologic features of endometriosis. Endometrial stroma and glands embedded in dense fibroconnectival tissue. H&E stain: 400×. (B) Immunohistochemistry for CD10 showing strong cytoplasmic positivity in stromal cells. 400×. (C) Immunohistochemistry for estrogen receptors showing nuclear positivity in both epithelial and stromal cells. 400×. (D) Immunohistochemistry for progesterone receptors showing nuclear positivity in both epithelial and stromal cells. 400×.

Mentions: A 24-year old woman, gravida 0, was admitted to outpatient clinics with a seven-month history of umbilical nodule. She stated that the nodule had slowly increased in size and had started to bleeding concomitantly with the menstrual periods in the previous 4 months. Her medical history was unremarkable and she denied symptoms of pelvic endometriosis such as dysmenorrhea, abdominal pain or dyspaurenia. She was not taking any oral contraceptives and had regular menstrual cycles. Physical examination revealed a brown, moderately tender nodule of about 1 centimeter in diameter located deep in the umbilical fold (Fig. 1A and B). On the basis of history and clinical findings, primary umbilical endometriosis was suspected and the patient was asked to return for further examination during her menstrual period, which occurred after one week. At this second look, the umbilical nodule appeared more tender, showing with signs of recent bleeding. An ultrasound confirmed the presence of a hypoechoic mass of 10 mm in the umbilicus, with no blood vessels at Doppler examination. The patient was thus referred to a gynecologist for clinical evaluation, transvaginal and abdominal ultrasonography. No clinical or ultrasonographic signs of endometriosis could be detected. Thus, surgical removal of the umbilical nodule was proposed and the patient was informed about the risk of local recurrence. In May 2011, the patient underwent excision of the nodule, saving the navel, under local anesthesia. The lesion was entirely excised deep to the fascia, together with a rim of macroscopic normal skin of 0.5 cm all around. There was no evidence of connection with the peritoneal cavity and the umbilicus was reconstructed with discontinuous suture using non-absorbable stitches. On gross examination a nodular, tan lesion of 1 cm × 0.8 cm covered by normal skin was appreciable. For the light microscopic examination, the specimen was fixed in 10% buffered formalin and embedded in paraffin. 4 μm-thick sections were stained with hematoxylin and eosin (H&E). Immunohistochemistry was performed using antibodies against Estrogen Receptor, Progesteron Receptor and CD10 (Novocastra, Leica Biosystems, Newcastle, UK). On microscopic examination, histologic sections revealed a glandular proliferation of monolayered endometrial epithelium surrounded by a cytostroma with extravasated erytrocytes (Figs. 2–3A). On immunohistochemistry findings, the epithelial and stromal cells too, showed a nuclear immunoreactivity for ER and PR (Fig. 3C and D); stromal cells expressed cytoplasmic positivity for CD10 (Fig. 3B). All these features were consistent with the diagnosis of umbilical endometriosis.


Primary umbilical endometriosis. Case report and discussion on management options.

Fancellu A, Pinna A, Manca A, Capobianco G, Porcu A - Int J Surg Case Rep (2013)

(A) Morphologic features of endometriosis. Endometrial stroma and glands embedded in dense fibroconnectival tissue. H&E stain: 400×. (B) Immunohistochemistry for CD10 showing strong cytoplasmic positivity in stromal cells. 400×. (C) Immunohistochemistry for estrogen receptors showing nuclear positivity in both epithelial and stromal cells. 400×. (D) Immunohistochemistry for progesterone receptors showing nuclear positivity in both epithelial and stromal cells. 400×.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860025&req=5

fig0015: (A) Morphologic features of endometriosis. Endometrial stroma and glands embedded in dense fibroconnectival tissue. H&E stain: 400×. (B) Immunohistochemistry for CD10 showing strong cytoplasmic positivity in stromal cells. 400×. (C) Immunohistochemistry for estrogen receptors showing nuclear positivity in both epithelial and stromal cells. 400×. (D) Immunohistochemistry for progesterone receptors showing nuclear positivity in both epithelial and stromal cells. 400×.
Mentions: A 24-year old woman, gravida 0, was admitted to outpatient clinics with a seven-month history of umbilical nodule. She stated that the nodule had slowly increased in size and had started to bleeding concomitantly with the menstrual periods in the previous 4 months. Her medical history was unremarkable and she denied symptoms of pelvic endometriosis such as dysmenorrhea, abdominal pain or dyspaurenia. She was not taking any oral contraceptives and had regular menstrual cycles. Physical examination revealed a brown, moderately tender nodule of about 1 centimeter in diameter located deep in the umbilical fold (Fig. 1A and B). On the basis of history and clinical findings, primary umbilical endometriosis was suspected and the patient was asked to return for further examination during her menstrual period, which occurred after one week. At this second look, the umbilical nodule appeared more tender, showing with signs of recent bleeding. An ultrasound confirmed the presence of a hypoechoic mass of 10 mm in the umbilicus, with no blood vessels at Doppler examination. The patient was thus referred to a gynecologist for clinical evaluation, transvaginal and abdominal ultrasonography. No clinical or ultrasonographic signs of endometriosis could be detected. Thus, surgical removal of the umbilical nodule was proposed and the patient was informed about the risk of local recurrence. In May 2011, the patient underwent excision of the nodule, saving the navel, under local anesthesia. The lesion was entirely excised deep to the fascia, together with a rim of macroscopic normal skin of 0.5 cm all around. There was no evidence of connection with the peritoneal cavity and the umbilicus was reconstructed with discontinuous suture using non-absorbable stitches. On gross examination a nodular, tan lesion of 1 cm × 0.8 cm covered by normal skin was appreciable. For the light microscopic examination, the specimen was fixed in 10% buffered formalin and embedded in paraffin. 4 μm-thick sections were stained with hematoxylin and eosin (H&E). Immunohistochemistry was performed using antibodies against Estrogen Receptor, Progesteron Receptor and CD10 (Novocastra, Leica Biosystems, Newcastle, UK). On microscopic examination, histologic sections revealed a glandular proliferation of monolayered endometrial epithelium surrounded by a cytostroma with extravasated erytrocytes (Figs. 2–3A). On immunohistochemistry findings, the epithelial and stromal cells too, showed a nuclear immunoreactivity for ER and PR (Fig. 3C and D); stromal cells expressed cytoplasmic positivity for CD10 (Fig. 3B). All these features were consistent with the diagnosis of umbilical endometriosis.

Bottom Line: Neither symptoms nor signs of local recurrence have been observed after 24 months.The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100 Sassari, Italy. Electronic address: afancel@uniss.it.

No MeSH data available.


Related in: MedlinePlus