DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163012

An atypical manifestation of inguinal endometriosis in the extra pelvic part of the round ligament: a case report

Vito Chiantera, Elene Abesadze, Mohamed Gamal Ibrahim, Anna Maria Dückelmann, Sylvia Mechsner

Abstract


Establishing the diagnostic and surgical management of the inguinal Endometriosis, with further investigation of the biological character.The imaging findings of CT and PET-CT, biopsy, ultrasound, open surgery of the inguinal region with intraoperative cryosection, confirmation and evaluation of tissue infiltration by endometriosis, laparoscopic removal of all endometriotic lesions, reconstruction of the groin. Based on the history of the 29-year-old patient, suffering from a painful growing induration of the inguinal region. Immunohistochemistry performed, in order to analyze the character of the inguinal endometriosis.CT, PET-CT and biopsy did not confirm the diagnosis of endometriosis. Considering, the progressive symptoms of the patient, was performed the surgical intervention. Open surgery of the inguinal region, with a preparation and separation of the groin fibrotic mass lead to the finding of an affected extra-peritoneal portion of the round ligament. Intraoperative cryosection confirmed endometriosis. Simultaneous laparoscopy showed peritoneal endometriosis (rASRM I) and an alteration of the inner round ligament, involving the inner inguinal channel in this process. All endometriotic lesions were removed and the inguinal region reconstructed. The immunohistochemical staining gave evidence of the endometriotic tissue, surrounded by smooth muscle metaplasia.We consider that, reporting this rare case of endometriosis, based on a case report and a literature review, affecting intra and extra peritoneal portion of the round ligament, is an important aid to avoid a wrong diagnosis and method of therapy in future. Our data demonstrated the fully recovery of the patient, after surgical treatment, reporting symptom-free status.

Keywords


Extra genital endometriosis, Endometriosis, Affecting the intra and extra-peritoneal portion of the round ligament, Inguinal endometriosis, Smooth muscle metaplasia

Full Text:

PDF

References


Ali Kemal Uzunlar FY, Mehmet Y, Özden K, Mehmet Ö. Inguinal Endometriosis: a Report of Two Cases and a Review of the Literature. Turk J Med Sci. 2000:389-92.

Brzezinski A, Durst AL. Endometriosis presenting as an inguinal hernia. Am J Obstet Gynecol. 1983;146:982-3.

Bungart. Inguinal endometriosis. Arch f klin. Chir.1925.

Calo PG, Esu F, Tatti A. Isolated inguinal endometriosis. Case report with ultrasonographic preoperative diagnosis. G Chir. 2011;32:263-5.

Candiani GB, Vercellini P, Fedele L. Inguinal endometriosis: pathogenetic and clinical implications. Obstetrics and gynecology. 1991;78:191-4.

Clausen I, Nielsen KT. Endometriosis in the groin. Int J Gynaecol Obstet. 1987;25:469-71.

Crispi CP, De Souza CA, Oliveira MA. Endometriosis of the round ligament of the uterus. J Minim Invasive Gynecol. 2012;19:46-51.

Ebert AD, Rosenow G, David M. Co-occurrence of atypical endometriosis, subserous uterine leiomyomata, sactosalpinx, serous cystadenoma and bilateral hemorrhagic corpora lutea in a perimenopausal adipose patient taking tamoxifen (20 mg/day) for invasive lobular breast cancer. Gynecol Obstet Invest. 2008;66:209-13.

Elemenoglou J, Skopelitou A, Nomikos I. Carcinoma of the inguinal region arising from endometriosis of the round ligament. Report of a case. Eur J Gynaecol Oncol. 1993;14:28-32.

Fedele L, Bianchi S, Frontino G. Radical excision of inguinal endometriosis. Obstetrics and gynecology. 2007;110:530-3.

Freed KS, Granke DS, Tyre LL. Endometriosis of the extraperitoneal portion of the round ligament: US and CT findings. J Clin Ultrasound. 1996;24:540-2.

Giudice LC.Clinical practice. Endometriosis. N Engl J Med. 2010;362:2389-98.

Hong YJ, Paik HC, Kim HJ. A case of parenchymal pulmonary endometriosis. Yonsei Med J. 1990;40:514-7.

Kirkpatrick A, Reed CM, Bui-Mansfield LT. Radiologic-pathologic conference of Brooke Army Medical Center: endometriosis of the canal of Nuck. AJR Am J Roentgenol. 2006;186:56-7.

Kratz. Anatomy of the female reproductive system. Current obstetric and gynecologic diagnosis and treatment. 6th ed. Norwalk, Connecticut: Apple-ton and Lange; 1987:1-46.

Latcher JW. Endometriosis of the umbilicus. Am J Obstet Gynecol. 1953;66:161-8.

Licheri S, Pisano G, Erdas E. Endometriosis of the round ligament: description of a clinical case and review of the literature. Hernia. 2005;9:294-7.

Mechsner S, Bartley J, Infanger M. Clinical management and immunohistochemical analysis of umbilical endometriosis. Archives of gynecology and obstetrics. 2009;280:235-42.

Mechsner S, Weichbrodt M, Riedlinger WF. Estrogen and progestogen receptor positive endometriotic lesions and disseminated cells in pelvic sentinel lymph nodes of patients with deep infiltrating rectovaginal endometriosis: a pilot study. Human reproduction. 2008;23:2202-9.

Meyer RM. AdenoWbrosis und Adenomyosis am Nabel. Handbuch der Gynäkologie. von Stöckel, Berlin. 1930;3:511-5.

Michowitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus. Dermatologica 1983;167:326-30.

Milam MR, Atkinson JB, Currie JL. Adenosarcoma arising in inguinal endometriosis. Obstetrics and gynecology. 2006;108:753-5.

Moore JG, Binstock MA, Growdon WA. The clinical implications of retroperitoneal endometriosis. Am J Obstet Gynecol. 1988;158:1291-8.

Moore WR. Inguinal endometriosis in bilateral hernia sacs associated with extensive pelvic endometriosis. Harper Hosp Bull. 1957;15:242-5.

Quagliarello J, Coppa G, Bigelow B. Isolated endometriosis in an inguinal hernia. Am J Obstet Gynecol. 1985;152:688-9.

Redwine DB. Attachment of endometrial cells to peritoneum--facilitated? Fertil Steril. 2001;76:421-2.

Sampson JEA. Peritoneal Endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal Of Obstetrics And Gynecology. 1927;14:93-4.

Scaglione V, Granieri A. [Bilateral endometriosis of the canal of Nuck simulating strangulated hernia. Ann Ostet Ginecol Med Perinat. 1981;102:55-61.

Singh KK, Lessells AM, Adam DJ. Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg. 1995;82:1349-51.

Sun ZJ, Zhu L, Lang JH. A rare extrapelvic endometriosis: inguinal endometriosis. J Reprod Med. 2010;55:62-6.

Terada S, Miyata Y, Nakazawa H, Higashimori T, Arai T, Kikuchi Y, et al. Immunohistochemical analysis of an ectopic endometriosis in the uterine round ligament. Diagn Pathol. 2006;1:27

Theander G, Haeger K. Angiography in the Diagnosis of Inguinal Endometriosis. Acta Radiol Diagn (Stockh). 1964;2:100-4.

Tokue H, Tsushima Y, Endo K. Magnetic resonance imaging findings of extrapelvic endometriosis of the round ligament. Jpn J Radiol. 2009;27:45-7.

Victory R, Diamond MP, Johns DA. Villar's nodule: a case report and systematic literature review of endometriosis externa of the umbilicus. J Minim Invasive Gynecol. 2007;14:23-32.