Case Report
Endometriotic umbilical port site metastasis after laparoscopy

https://doi.org/10.1016/j.ajog.2005.05.088Get rights and content

We present the case of a 40-year-old woman who had been previously operated for endometrioma 2 years ago by laparoscopy, with the complaint of an umbilical mass with cyclical pain pattern. The dark-colored mass was excised and pathology report revealed it to be an endometriotic implant.

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Case report

A 40-year-old woman presented with a recent history of irregular umbilical mass and an associated severe cyclic pain during her menses. The mass was dark colored, hard, and measured 2 to 3 cm in diameter and was located on the previous laparoscopic umbilical port site scar (Figure 1). Ultrasonography of the lesion revealed a hypoechoic 29 × 21 × 26 mm lobulated lesion located at the subcutaneous tissue just below the umbilicus with intense arteriolar network image seen during Doppler

Comment

Although umbilical endometriosis is uncommonly reported, it is usually easily diagnosed because of the cyclic character of the pain it elucidates, as in our subject. Simple excision of the umbilical endometrioma is the treatment of choice.10

The histogenesis of endometriosis is still unknown, although there has been a lot of research as to its origin. In the case of an umbilical port site endometrioma, the lesion may have developed from peritoneal seeding of cells because of pneumoperitoneum or

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    A search of the Medline database (1966 to present), using the keywords “endometriosis” and “umbilicus” and the Boolean operator “and,” demonstrated 52 separate, relevant studies in the English language since 1966. Of these, 9 were excluded: 1 for umbilical deciduosis,7 1 for umbilical endosalpingiosis,8 1 case was listed twice,8 1 case was a double publication,9 2 papers contained only review material,10,11 and 3 papers were related to gynecologic malignancies in the umbilicus,12–14 leaving 43 papers for inclusion.3,4,8,15–53 Additionally, we conducted a separate search using the terms “umbilicus and endometriosis” and “umbilical and endometriosis” and combined them using the Boolean operator “or”, resulting in 73 reports when limited to “human” and “English” language articles.

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