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5-Year data analysis of patients following abdominal wall endometrioma surgery.

Khamechian T, Alizargar J, Mazoochi T - BMC Womens Health (2014)

Bottom Line: Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE.We found a previous history of caesarean section in all of the patients.We can conclude that there is a high prevalence of caesarean sections among the women with AWE.

View Article: PubMed Central - PubMed

Affiliation: Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, I.R Iran. unlimited_28008@yahoo.com.

ABSTRACT

Background: Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium embedded in the subcutaneous fatty layer and the muscles of abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a rare condition; however, it is usually known to develop along with previous surgical scars. Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE.

Methods: We evaluated the data of the patients who underwent AWE surgery between March 2009 and March 2014.

Results: The mean age of the patients was 32.5 years. We found a previous history of caesarean section in all of the patients. The most frequent symptoms of the patients were abdominal mass sensation and abdominal pain. Invasion of endometriosis to fat layer, fascia, muscular layer, and peritoneum was recorded. Three masses were located within the scar regions.

Conclusions: We can conclude that there is a high prevalence of caesarean sections among the women with AWE.

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Related in: MedlinePlus

Histopathological characteristics of endometriosis in different tissue types. A: Endometrial strauma and glands in fatty connective tissue (X10). B: Endometrial strauma and glands in fatty connective tissue (X40). C: Endometrial strauma and glands in fibro-connective tissue (X10). D: Endometrial strauma and glands in muscular tissue (X10). E: Endometrial strauma and glands in muscular tissue adjacent to fatty layer (X10).
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Fig1: Histopathological characteristics of endometriosis in different tissue types. A: Endometrial strauma and glands in fatty connective tissue (X10). B: Endometrial strauma and glands in fatty connective tissue (X40). C: Endometrial strauma and glands in fibro-connective tissue (X10). D: Endometrial strauma and glands in muscular tissue (X10). E: Endometrial strauma and glands in muscular tissue adjacent to fatty layer (X10).

Mentions: Histological confirmation of endometrioma is based on detecting at least two of the three following features: endometrial stroma, endometrial like glands and hemosiderin pigment [10]. After histopathological confirmation (Figure 1), the data of 30 patients who underwent AWE surgery were entered in our study. All the patients had at least two features of endometrioma. Table 1 summarizes the characteristics of the patients with abdominal wall endometriosis. The age of the patients ranged from 23 to 67 years. The mean age of the patients was 32.5 ± 8.24 years. Their number of parities ranged from one to four. We found a previous history of caesarean section in all of the patients. Eleven patients (36.6%) had a single caesarean section. Fourteen patients (46.7%) had two caesarean sections and five (16.7%) had three caesarean sections. Eight patients (26.7%) had surgeries other than caesarean section. These surgeries include one myomectomy, three hysterectomies, one tubalectomy, and three appendectomies. All patients had a notable mass as a presenting symptom. Other than the mass, 24 patients (80%) experienced pain, among whom 14 patients (46.7%) experienced cyclic pain. Two patients (6.7%) had dyspareunia, three (10%) had dysmenorrhea, and one (3.3%) had bleeding as presenting symptoms. Four patients did not have any symptoms and AWE was discovered during the caesarean sections. The mean duration of symptoms was 12.7 ± 10.44 months, ranging from three to forty-five months. The mean time between the previous surgery and diagnosis of AWE was 30.5 ± 12.65 months. In 28 patients (93.3%), the ultrasonography was used to diagnose AWE, computed tomography (CT) scan and magnetic resonance imaging (MRI) were used in five (16.6%) and two (6.6%) patients, respectively. Twenty-seven patients (90%) had a single mass, whereas, three (10%) had two masses at the time of diagnosis. In nineteen patients (63.3%), the initial diagnosis was AWE, whereas abdominal wall tumour was diagnosed in four patients (13.3%), incisional hernia in three (10%) cases, suture granuloma in two cases (6.7%), and inguinal hernia and desmoid tumour each in one case (3.3%). The location of the masses was in or under the scar of the previous surgery in 21 patients (70%) (in three cases the mass was located in the scar), hypochondrium away from the scar and umbilicus each in four cases (13.3%), and groin region in one case (3.3%). The mean diameter of the masses was 2.59 ± 1.21 cm, ranging between 1 cm and 6 cm. Nine cases (30%) had a mass in the fat tissue, fourteen (46.7%) in muscle tissue, eleven (36.7%) in the fascia of the abdomen muscles, ten (33.3%) in the omentum, and one (3.3%) in the dermis. Hematoma and necrosis were observed in one (3.3%) and two patients (6.7%), respectively. No case of malignancy was reported among our study patients. All the patients underwent follow-up tests and one patient was diagnosed with a recurred mass after six months, which was removed with clear margins.Figure 1


5-Year data analysis of patients following abdominal wall endometrioma surgery.

Khamechian T, Alizargar J, Mazoochi T - BMC Womens Health (2014)

Histopathological characteristics of endometriosis in different tissue types. A: Endometrial strauma and glands in fatty connective tissue (X10). B: Endometrial strauma and glands in fatty connective tissue (X40). C: Endometrial strauma and glands in fibro-connective tissue (X10). D: Endometrial strauma and glands in muscular tissue (X10). E: Endometrial strauma and glands in muscular tissue adjacent to fatty layer (X10).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4263010&req=5

Fig1: Histopathological characteristics of endometriosis in different tissue types. A: Endometrial strauma and glands in fatty connective tissue (X10). B: Endometrial strauma and glands in fatty connective tissue (X40). C: Endometrial strauma and glands in fibro-connective tissue (X10). D: Endometrial strauma and glands in muscular tissue (X10). E: Endometrial strauma and glands in muscular tissue adjacent to fatty layer (X10).
Mentions: Histological confirmation of endometrioma is based on detecting at least two of the three following features: endometrial stroma, endometrial like glands and hemosiderin pigment [10]. After histopathological confirmation (Figure 1), the data of 30 patients who underwent AWE surgery were entered in our study. All the patients had at least two features of endometrioma. Table 1 summarizes the characteristics of the patients with abdominal wall endometriosis. The age of the patients ranged from 23 to 67 years. The mean age of the patients was 32.5 ± 8.24 years. Their number of parities ranged from one to four. We found a previous history of caesarean section in all of the patients. Eleven patients (36.6%) had a single caesarean section. Fourteen patients (46.7%) had two caesarean sections and five (16.7%) had three caesarean sections. Eight patients (26.7%) had surgeries other than caesarean section. These surgeries include one myomectomy, three hysterectomies, one tubalectomy, and three appendectomies. All patients had a notable mass as a presenting symptom. Other than the mass, 24 patients (80%) experienced pain, among whom 14 patients (46.7%) experienced cyclic pain. Two patients (6.7%) had dyspareunia, three (10%) had dysmenorrhea, and one (3.3%) had bleeding as presenting symptoms. Four patients did not have any symptoms and AWE was discovered during the caesarean sections. The mean duration of symptoms was 12.7 ± 10.44 months, ranging from three to forty-five months. The mean time between the previous surgery and diagnosis of AWE was 30.5 ± 12.65 months. In 28 patients (93.3%), the ultrasonography was used to diagnose AWE, computed tomography (CT) scan and magnetic resonance imaging (MRI) were used in five (16.6%) and two (6.6%) patients, respectively. Twenty-seven patients (90%) had a single mass, whereas, three (10%) had two masses at the time of diagnosis. In nineteen patients (63.3%), the initial diagnosis was AWE, whereas abdominal wall tumour was diagnosed in four patients (13.3%), incisional hernia in three (10%) cases, suture granuloma in two cases (6.7%), and inguinal hernia and desmoid tumour each in one case (3.3%). The location of the masses was in or under the scar of the previous surgery in 21 patients (70%) (in three cases the mass was located in the scar), hypochondrium away from the scar and umbilicus each in four cases (13.3%), and groin region in one case (3.3%). The mean diameter of the masses was 2.59 ± 1.21 cm, ranging between 1 cm and 6 cm. Nine cases (30%) had a mass in the fat tissue, fourteen (46.7%) in muscle tissue, eleven (36.7%) in the fascia of the abdomen muscles, ten (33.3%) in the omentum, and one (3.3%) in the dermis. Hematoma and necrosis were observed in one (3.3%) and two patients (6.7%), respectively. No case of malignancy was reported among our study patients. All the patients underwent follow-up tests and one patient was diagnosed with a recurred mass after six months, which was removed with clear margins.Figure 1

Bottom Line: Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE.We found a previous history of caesarean section in all of the patients.We can conclude that there is a high prevalence of caesarean sections among the women with AWE.

View Article: PubMed Central - PubMed

Affiliation: Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, I.R Iran. unlimited_28008@yahoo.com.

ABSTRACT

Background: Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium embedded in the subcutaneous fatty layer and the muscles of abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a rare condition; however, it is usually known to develop along with previous surgical scars. Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE.

Methods: We evaluated the data of the patients who underwent AWE surgery between March 2009 and March 2014.

Results: The mean age of the patients was 32.5 years. We found a previous history of caesarean section in all of the patients. The most frequent symptoms of the patients were abdominal mass sensation and abdominal pain. Invasion of endometriosis to fat layer, fascia, muscular layer, and peritoneum was recorded. Three masses were located within the scar regions.

Conclusions: We can conclude that there is a high prevalence of caesarean sections among the women with AWE.

Show MeSH
Related in: MedlinePlus