Jaw region endometriosis: case report

Introduction: Endometriosis is a chronic gynecological disease, which refers to the presence of endometrial glands and stroma outside the uterine endometrium. This entity has a frequency of 10 to 15% in women of reproductive age, and its most common site of presentation is the ovary. At the extrapelvic level, the most common location is the gastrointestinal and genitourinary location. However, it can occur in any location. Presentation: The case of a 40-year-old female patient with a face tumor in the mandibular region is described, presenting with a disease time of 2 years. Among the important antecedents, two months before the appearance of the tumor region, the patient underwent endodontic surgery of a lower molar tooth, contiguous to the mandibular. Likewise, one month before the appearance of the tumor, the patient underwent an exploratory laparoscopy for electrofulguration of endometriotic foci in the uterine myometrium. The patient underwent a surgical resection of the tumor in the mandibular region described; and after reviewing the histological and immunohistochemical slides at the institution, the diagnosis of endometriosis was established. Conclusion: Extrapelvic endometriosis is rare in our country, and its diagnosis requires experience and visual training in the recognition of normal endometrial tissue. The presentation of this case was considered important because it would be the first case reported in Peru and in the world, of an endometriosis located in the mandibular region.

Case Report: Extrapelvic Endometriosis in the Medial Thigh

Extrapelvic endometriosis, although rare, can present in the musculoskeletal system of reproductive-age women and cause significant pain and morbidity. The pathophysiology of this disease is not well understood. In this study, we described the case of a 39-year-old women with an inner-thigh mass causing catamenial pain. Core-biopsy of the mass confirmed endometriosis and she was referred to minimally-invasive gynecology for management. Surgical excision was performed by a multidisciplinary team and she remains pain-free postoperatively on hormonal therapy. Unique to this case, the patient had a history of pelvic fracture. Through this case report, we discuss possible pathophysiologic mechanisms of extrapelvic musculoskeletal endometriosis including the stem/progenitor cell theory and the role that musculoskeletal trauma may have in the development of this condition. Gynecologists play an important role in the recognition, diagnosis, and management of musculoskeletal endometriosis.

Malignant transformation of hepatic endometriosis: a case report and literature review

Background Extrapelvic endometriosis is defined as the presence of ectopic endometrial tissue in structures outside the pelvis. Although extra-pelvic endometriosis is generally considered benign conditions, malignant potential within endometriotic foci occurs even after definitive surgery. Malignant transformation of hepatic endometriosis is extremely rare. Preoperative diagnosis of this cancer is difficult, and no guidelines on the optimal management currently exist. Here, we present a case report of malignant transformation of hepatic endometriosis and a brief literature review to highlight the current knowledge of the prevalence, clinical features, diagnosis, and management of this condition. Case presentation A 50-year-old woman with a 2-year duration of progressive right upper quadrant abdominal pain was admitted to the hospital. She underwent hysterectomy and bilateral salpingo-oophorectomy for benign conditions 4 years prior. Tumor markers demonstrated elevated carbohydrate antigen (CA)-199 112U/mL (normal range: 0–35U/mL) only. Radiological imaging suggested the presence of a 10.7 × 7.7-cm mass in the right lobe of the liver extending to the diaphragm. The intraoperative frozen sections suggested malignant tumor. Right hepatectomy with infiltrating diaphragm resection was performed. The final pathology with immunohistochemistry staining confirmed endometrioid adenocarcinoma in the liver originating from preexisting hepatic endometriosis. After the multidisciplinary team meeting, the consensus was surgery followed by adjuvant chemotherapy. To our knowledge, this is the first case of Chinese woman of a malignant liver tumor originating from endometriosis ever reported by reviewing the current English medical literature. Conclusion Though rare, extrapelvic endometriosis-associated cancers should be considered as differentiated diagnosis even after hysterectomy and bilateral salpingo-oophorectomy. This case highlights the importance of collaborative efforts across multiple disciplines for accurate diagnosis and appropriate treatment of malignant transformation of hepatic endometriosis.

Retrospective clinicopathological analysis of scar endometriosis and its surgical management

Background: Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.Methods: It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh, recurrence rate on follow up were noted.Results: Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wall lesions were demonstrated in all cases. Diagnostic laparoscopy was done in 26 of these patients and showed associated endometriosis in 9 patients. Plane of endometriosis was found to be subcutaneous for 9 cases, sheath in 7 and muscular in 12 cases. HPE was proven in all cases.Conclusions: Scar endometriosis is rare. High index of suspicion is needed for diagnosis, especially in cases of previous caesarean sections. MRI and USG are useful tools for diagnosis. Complete wide local excision of scar endometriosis is the primary modality of treatment. Diagnostic laparoscopy along with the procedure is helpful in diagnosing associated pelvic endometriosis.

Narrow band imaging for thoracic endometriosis

Background The thoracic cavity is the most frequent site of extrapelvic endometriosis. It exhibits a wide variety of clinical manifestations, such as chest pain, cough, and respiratory distress, and is frequently associated with pelvic endometriosis. Although histological confirmation is the gold standard for a definitive diagnosis, endoscopic identification of the affected area is often difficult. Narrow band imaging (NBI) is an imaging technique that emphasizes vascular structures and is reported to be useful in the diagnosis of pelvic endometriosis. Case presentations A 31-year-old woman and 39-year-old woman developed a recurrent right pneumothorax during their menstruation cycles. They both had no medical history suggesting pelvic endometriosis. We planned an elective video-assisted thoracoscopic surgery for the suspicion of thoracic endometriosis. In addition to white light alone, an NBI observation enhanced the microvasculature of the suspected lesions and allowed us to identify the affected area more clearly. Partial resections of the diaphragm were performed. Histopathological and immunohistochemical studies of each specimen confirmed the diagnosis of extrapelvic endometriosis. Conclusions NBI may improve the diagnostic accuracy for thoracic endometriosis, especially in clinically suspected patients but without a history of pelvic endometriosis.

The ultrasound of subcutaneous extrapelvic endometriosis

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.

General surgeon’s experience in managing extra pelvic endometriosis

Two unusual cases of extrapelvic endometriosis are discussed here. Both presented themselves to the general surgeons. Case 1 presented with cyclical painful abdominal wall mass at the left iliac fossa region. Ultrasound and computed tomography scan showed a solitary mass at the subcutaneous region and fine needle aspiration cytology revealed endometriosis. The patient underwent wide surgical excision and recovered. Case 2 presented with painless swelling at the left inguinal area whilst being pregnant. Surgical exploration was performed for ‘left inguinal hernia’ but an encysted mass was found in the inguinal canal which was excised. Histopathological examination reported endometriosis. Both cases were subsequently under gynaecological follow-up. It is important for the surgeons to include endometriosis as one of the differential diagnosis in the management of their female patients with mass or swelling.

One-stage, radical laparoscopic endometriosis excision involving three different organ systems: A case report from tertiary referral center

Introduction: We present a case of an extensive endometriosis involving left paracolpium and left parametrium, rectovaginal septum, urinary bladder, left interiliac region between artery and vein, left ureter and rectum, presenting as dysmenorrhoea, alternating bouts of diarrhea and constipation and hydronephrosis. Methods: Laparoscopic surgery made by a multidisciplinary team consist of gynecologic, abdominal surgeon and urologist. Results: Successfully managed deep infiltrated endometriosis. Conclusion: The aim of this report is to demonstrate benefit of one-stage, minimally invasive radical surgical procedure performed in a tertiary referral center. To the best of our knowledge, this report presents an extremely complex case because we successfully managed deep infiltrating endometriosis in three different organ systems at the same time, using minimally invasive nerve-sparing technique. A case with the same constellation has not been published yet since reported cases of extrapelvic endometriosis chiefly address one organ system involvement.