Endometrioma in the Abdominal Incisional Scar

ABSTRACT

Endometriosis is a condition where uterine mucosal tissue is located outside of the uterus, which may be pelvic or extrapelvic. The term endometrioma is used when extrapelvic endometriosis appears as a discrete mass. A 34-year-old female, with an abdominal mass along the scar site of a cesarean section, was transferred from her local hospital following the diagnosis of a foreign body granuloma or infected lipoma. The patient had history of two cesarean sections, 5 and 7.5 years previously. The abdominal mass was associated with abdominal pain, which increased in severity during her menstrual cycle. The ultrasonography showed a solid irregular, ill defined mass, with heterogeneous echogenicity. The cytological findings showed epithelial and stromal cells. A mass excision was performed under local anesthesia. The final pathology results confirmed an endometrioma in the abdominal wall, and the microscopic findings indicated benign endometrial glands, with surrounding spindled endometrial cells in the soft tissue of the abdominal wall. The treatment of choice is wide local excision of endometrial tissue, with a clear margin. An endometrioma in the abdominal scar, following a cesarean section, is a rare event, but may be more frequent than estimated from the literature. This case was reported with a brief review of the literature.