ABSTRACT
Presentamos a dos mujeres -de 40 y 42 años- con endometriosis colorrectal, ambas con antecedente de endometriosis pélvica y episodios de rectorragia simultáneos con la menstruación. En las evaluaciones endoscópicas detectamos una tumoración sigmoidea y una tumoración rectosigmoidea respectivamente, que aparentaron corresponder a cáncer colorrectal estenosante de origen epitelial.
We present two women of 40 and 42 years with colorectal endometriosis, both with a history of pelvic endometriosis and simultaneous episodes of rectal bleeding with menstruation. In endoscopic evaluations detected a sigmoid tumor and rectosigmoid tumor respectively, which apparently corresponds to stenosing colorectal cancer of epithelial origin.
Subject(s)
Adult , Female , Humans , Colorectal Neoplasms/diagnosis , Endometriosis/diagnosis , Intestinal Obstruction/etiology , Rectal Diseases/diagnosis , Sigmoid Diseases/diagnosis , Diagnosis, Differential , Endometriosis/complications , Intestinal Obstruction/diagnosis , Rectal Diseases/complications , Sigmoid Diseases/complicationsABSTRACT
PURPOSE: Endometriosis is the heterotropic occurrence of island of endometrial glands and stroma outside of uterus. It common occurs in pelvic cavity, but rarely at the ectopic area of extra-pelvic cavity. The aim of this study was to evaluate the clinical characteristics of extrapelvic endometriosis in order to help diagnosis and treatment. METHODS: Between January 2001 and June 2007, 22 patients who underwent surgery and was diagnosed as ectopic endometriosis of extra-pelvic cavity at Bundang CHA hospital were retrospectively reviewed with medical records and a telephone interview. RESULTS: All cases were women in their reproductive age, with a median age of 33 years (range 24~49 years). 17 of 22 cases were endometriosis in the scarring tissue of prior caesarean section wound on abdomen. 1 case in vaginal orifice on episiotomy wound of perineum, 1 case in femoral ring area and 3 cases in appendix. All patients except endometriosis of appendix, were presented with mass, pain and symptoms almost associated with menstruation. 18 of 22 cases were suspected of having extra-pelvic endometriosis due to their specific clinical features, 4 cases were suspected of hernia and acute appendicitis. All patients were treated with surgery. None has revisited to clinics due to recurrence. CONCLUSION: Women who have mass or lump in surgical scar and symptoms associated with menstruation period should be suspected of having endometriosis. Endometriosis of surgical scaring tissue should be treated by wide local excision to prevent local recurrence.
Subject(s)
Female , Humans , Pregnancy , Abdomen , Appendicitis , Appendix , Cesarean Section , Cicatrix , Endometriosis , Episiotomy , Hernia , Medical Records , Menstruation , Perineum , Retrospective Studies , Telephone , UterusABSTRACT
OBJECTIVE: To examine survivin expression in extrapelvic endometriosis. METHODS: The study group consisted of 14 cases with extrapelvic endometriosis which were confirmed histologically. The control group (total, n=47) was divided into 2 groups. Group I included normal endometrium (n=34) obtained from hysterectomy specimens with myoma and without endometriosis. Group II included ovarian endometrioma (n=13) obtained from laparoscopy. Expression of survivin was immunohistochemically confirmed. RESULTS: In extrapelvic endometriosis, the expression of nucleus in glandular epithelium and stromal cells were significantly stronger than normal endometrium. But cytoplasm expression of glandular epithelial cells and stromal cells in extrapelvic endometriosis showed statistically lower in comparison with normal endometrium. In ovarian endometrioma, the expression of nucleus in glandular epithelial cells and stromal cells was significantly stronger than normal endometrium. But the expression of nucleus in glandular epithelial cells with ovarian endometrioma was stronger than during proliferative phase but was not significant. Also cytoplasm expression of ovarian endometrioma was lower than normal endometrium. There was no difference in survivin expression between extrapelvic endometriosis and ovarian endometrioma. CONCLUSIONS: In extrapelvic endometriosis, survivin expression was stronger than normal endometrium except cytoplasm. Our findings suggest that increased survivin expression may contribute to survival of extrapelvic implants.
Subject(s)
Female , Cytoplasm , Endometriosis , Endometrium , Epithelial Cells , Epithelium , Hysterectomy , Laparoscopy , Myoma , Stromal CellsABSTRACT
Extrapelvic endometriosis is a rare disease. The majority of extrapelvic endometriosis cases involve scar tissue following obstetric and gynecologic procedures. We have treated two cases of extrapelvic incisional endometriosis. A 39 year old female patient with cyclic vaginal spotting after laparoscopic assisted vaginal hysterectomy due to uterine myoma and a 35 year old female patient with a painful palpable abdominal mass after cesarean section. Both underwent complete excision and were proven to have endometriosis by pathology. Here we report on both cases and review the medical literatures.
Subject(s)
Adult , Female , Humans , Pregnancy , Cesarean Section , Cicatrix , Endometriosis , Hysterectomy, Vaginal , Leiomyoma , Metrorrhagia , Pathology , Rare DiseasesABSTRACT
PURPOSE: Endometriosis is a condition where uterine mucosal tissue is located outside the uterus, and may be pelvic or extrapelvic. Extrapelvic endometriosis is a diagnostic challenge due to its very low incidence. The aim of this study was to analyze the clinical features of extrapelvic endometriosis in order to help diagnosis and treat this condition. METHODS: Between January 1998 and May 2005, 6 patients diagnosed with extrapelvic endometriosis after surgery at our hospital were retrospectively reviewed by a telephone interview. RESULTS: All cases were women in their reproductive years, with a median age of 37.5 years (range 34~50 years). Five of the six cases had a prior medical history of a caesarean section and 1 case had episiotomy during a normal vaginal delivery. Five cases were located in the lower abdomen and 1 case was located in the perineum. All patients presented with a surgical scar mass associated with pain and size that increased during menstruation. The median mass size was 2.5 cm (range 1~3.4 cm). The mass was found after a median interval of 13 months (range 1~45 months) from pelvic surgery. All cases were suspected of having extrapelvic endometriosis due to their specific clinical features, and 2 of them were confirmed by fine needle aspiration cytology (FNAC). All the patients were treated with a surgical excision. There was no recurrence after a median follow up of 27 months (range 4~86 months). CONCLUSION: Patients with a surgical scar mass associated with pain that increases in size during menstruation should be suspected of having extrapelvic endometriosis and be treated by a complete surgical excision to prevent a recurrence.
Subject(s)
Female , Humans , Pregnancy , Abdomen , Biopsy, Fine-Needle , Cesarean Section , Cicatrix , Diagnosis , Endometriosis , Episiotomy , Follow-Up Studies , Incidence , Interviews as Topic , Menstruation , Mucous Membrane , Perineum , Recurrence , Retrospective Studies , UterusABSTRACT
Endometriosis is defined as the presence of endometrial tissue, e.g. gland and stroma, outside the uterus. Extrapelvic endometriosis is a rare condition but it occurrs in the gastrointestinal tract, kidney, pancreas, umbilicus, perianal area, abdominal scar tissue, lung or central nervous system except spleen. We have experienced a case of extrapelvic endometriosis in an adolescent girl, who complained of severe left upper quadrant abdominal pain and vomiting. The lesion was diagnosed by abdominal ultrasonography and computerized tomography, and confirmed histologically by exploratory laparotomy and mass excision biopsy. During menstration after surgery, she had no complaint of abdominal pain nor dysmenorrhea. We report this case with a review of associated literature.