Cic edizioni internazionali
Prevention and Research

The primary and secondary endometriosis within abdominal wall

Case report, 1 - 3
doi: 10.11138/PER/2013.2.1.001
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Background: endometriosis is defined as the presence of functional endometrial glands and stroma outside the uterine cavity. It’s classified in a primary and a secondary form. The endometriosis is a common gynecological disease with a prevalence estimated between 8-15% and it usually occurs in women during the reproductive years, with the maximum incidence between 30-and 40-year-old women.
The primary endometriosis form of the rectus abdominis muscle includes lesions that are not a result of a previous surgical procedure. This is an exceptional occurrence and only 18 cases have been described in Literature from 1984 to 2004. The incidence of the secondary form has been estimated around 0,003%-4%.
Cases: we report a rare case of primary endometrios in the inguinal area and a case of scar endometriosis. In these two cases the treatment was the surgical excision that should include 5-10
mm of healthy tissue.
In the third case during operative dissection forbhernia, a hard granulomatous lesion was found and removed.
Follow-up was performed by subjecting the patients to a transvaginal and trans abdominal ultrasonography, detection of serum level of CA-125 and a gynaecological evaluation 6 months after surgery. An MRI scan was performed 1 year after surgery. All tests gave negative results.
Discussion: the causes of endometriosis are unknown, but there are several theories. The most popular is the retrograde menstruation, proposed by Sampson. A second theory is the vascular-lymphatic dissemination that can explain occurrence of endometriosis in such distant sites. A third theory is coelomic metaplasia: this would explain endometriosis in postmenopausal women and in male patients, who are undergoing estrogen therapy for prostatic carcinoma. The symptoms of the disease are cyclic or catamenial pain associated with a palpable mass. The differential diagnosis includes: hernia, hematoma, lymphoadenopathy, lymphoma, lipoma, abscess, subcutaneous cyst, neuroma and desmoids tumor. The serum level of CA-125 can be slightly increased. Additional studies such as ultrasound, FNA (Fine-needle aspiration cytology), CT scan or MRI scan may be needed for the final diagnosis. FNA has been used in the preoperative assessment of abdominal wall masses and it has been reported to be useful in excluding the possibility of malignancy, but seems to be inconclusive in formulating diagnosis and it has
been associated to an increased risk of recurrence.
MRI may show characteristic findings due to iron in the hemosiderin deposits in an endometrioma. The preferred treatment is a surgical wide excision.
Conclusions: the preferred treatment is a surgical wide excision with clear margins, that is decisive as demonstrated by follow-up. Recurrence is rare, usually within 1 year and it is likely the result of an inadequate excision. Medical treatment of abdominal wall endometriosis is usually unsuccessful.

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  1. The primary and secondary endometriosis within abdominal wall
    Capoano R., Tesori M.C., Mastroluca E., Lacroce G., Police A., Llange K., Gianfrancesco E., Donello C., Lombardo F., Salvati B.
    doi: 10.11138/PER/2013.2.1.001