Endometriosis umbilical primaria: reporte de dos casos / Primary umbilical endometriosis: two case reports

INTRODUCCIÓN: La endometriosis es una patología benigna, dependiente de estrógenos, en la que el tejido que normalmente crece dentro del útero aparece fuera de este. Su localización habitual es en la pelvis, pero en ocasiones puede aparecer en otras áreas, como es el caso de la endometriosis umbilical. OBJETIVO: Familiarizar al ginecólogo con esta patología y entregar una serie de herramientas para diagnosticar, tratar y seguir a las pacientes que la presentan. CASOS CLÍNICOS: Se presentan dos casos clínicos de endometriosis umbilical primaria diagnosticados en el Hospital La Paz, en Madrid (España), entre los años 2018 y 2019. Las pacientes, de 30 y 34 años, consultaron por dolor o sangrado umbilical durante la menstruación. Ninguna tenía antecedentes de patología ginecológica ni cirugía abdominal previa. Tras una exhaustiva exploración física y una ecografía de alta resolución, se decidió extirpar la lesión con la colaboración del servicio de cirugía plástica. En ambos casos, el estudio anatomopatológico confirmó que se trataba de tejido endometriósico. Las dos pacientes presentaron una buena evolución posquirúrgica, sin recidivas hasta la fecha. CONCLUSIONES: La endometriosis umbilical primaria es una patología infrecuente, pero es necesario incluirla en el diagnóstico diferencial de una mujer con un nódulo umbilical. Siempre deben realizarse una exploración física exhaustiva y una ecografía ginecológica, para descartar posibles patologías concomitantes. El tratamiento de elección es la extirpación quirúrgica de la lesión y el diagnóstico final se establece con el estudio anatomopatológico.

INTRODUCTION: Endometriosis is an estrogen-dependent benign pathology in which endometrial tissue develops outside the uterus. Its most frequent location is the pelvis, although it can appear in other areas such as the umbilicum. OBJECTIVE: To familiarize the gynecologist with this pathology and provide a series of tools to diagnose, treat and provide continued care to these patients. CASE REPORTS: Retrospective study of two clinical cases of primary umbilical endometriosis diagnosed at La Paz University Hospital, in Madrid (Spain), between 2018 and 2019. Both patients (30 and 34 years old respectively) presented with pain and/or bleeding around the umbilical area during menstruation. Neither of them had any previous gynecologic conditions or abdominal surgeries. After exhaustive physical examination and a high-resolution ultrasound, lesions were surgically removed in collaboration with the plastic surgery department. In both cases, histology confirmed the presence of endometrial tissue. Both patients made a full recovery after surgery and havent had a recurrence of said lesions. CONCLUSIONS: Primary umbilical endometriosis is an infrequent disease. However, it must be included in the differential diagnosis of umbilical nodes in women. Exhaustive physical examination and gynecologic ultrasound should always be performed to rule out any other pathologies. Surgical removal of the nodes is the preferred treatment, and the final diagnosis is reached through histology.

Nódulo de Villar: una rara causa de nódulo umbilical / Villar's nodule: a rare cause of umbilical nodule

RESUMEN La endometriosis cutánea es infrecuente, pero representa la localización más común fuera de la pelvis. Las formas primarias pueden ubicarse en la cicatriz umbilical, región perianal o inguinal. Presentamos el caso de una paciente con diagnóstico de nódulo de Villar que fue tratada exitosamente con la resec ción de este. La fisiopatología de la entidad no está aún bien definida. La sospecha del cuadro es funda mental para el diagnóstico. Los métodos complementarios de imágenes pueden evaluar diagnósticos diferenciales. El tratamiento es quirúrgico. En la mayoría de los casos el pronóstico es favorable, con bajos porcentajes de recidiva.

ABSTRACT Cutaneous endometriosis is a rare condition but represents the most common extrapelvic location. Primary cutaneous endometriosis may develop in the umbilicus, perianal region or inguinal region. We report the case of a female patient with a diagnosis of Villar's nodule that was successfully treated with surgery. The pathophysiology of this entity is not well defined yet. The clinical suspicion is fundamental for the diagnosis. Complementary imaging test are used to rule out the differential diagnoses. Surgery is indicated in all the cases. The prognosis is favorable in most cases, with low rate of recurrence.

Primary Cutaneous Endometriosis of Umbilicus

Cutaneous endometriosis is defined by the presence of endometrial glands and/or stroma in skin and represents less than 1% of all ectopic endometrium. Cutaneous endometriosis is classified as primary and secondary. Primary cutaneous endometriosis appears without a prior surgical history and secondary cutaneous endometriosis mostly occurs at surgical scar tissue after abdominal operations. The most widely accepted pathogenesis of secondary endometriosis is the iatrogenic implantation of endometrial cells after surgery, such as laparoscopic procedures. However, the pathogenesis of primary endometriosis is still unknown. Umbilical endometriosis is composed only 0.4% to 4.0% of all endometriosis, however, umbilicus is the most common site of primary cutaneous endometriosis. A 38-year-old women presented with solitary 2.5×2.0-cm-sized purple to brown colored painful nodule on the umbilicus since 2 years ago. The patient had no history of surgical procedures. The skin lesion became swollen with spontaneous bleeding during menstruation. The skin lesion was diagnosed as a keloid at private hospital and has been treated with lesional injection of steroid for several times but there was no improvement. Imaging studies showed an enhancing umbilical mass without connection to internal organs. Biopsy specimen showed the several dilated glandular structures in dermis. They were surrounded by endometrial-type stroma and perivascular infiltration of lymphocytes. The patient was diagnosed as primary cutaneous endometriosis and skin lesion was removed by complete wide excision without recurrence. We report an interesting and rare case of primary umbilical endometriosis mistaken for a keloid and review the literatures.

A Case of Primary Cutaneous Endometriosis at the Unbilicus / 대한산부인과학회지

Cutaneous endometriosis seems to be more common in women who have had a pelvic or abdominal operation and primary cutaneous endometriosis is very rare. In our hospital we experienced a 41-year-old woman who complained of the appearance at the umbilicus of a nodule and had not had operation. This nodule was responsible for recurrent pain and increasing in size and it was excised. Pathology findings revealed cutaneous endometriosis. So we present a case of primary cutaneous endometriosis with a brief review of literature.