Umbilical Endometriosis in a Surgically Naïve Multiparous Young Female.

The existence of functional endometrial tissue outside the uterus is known as endometriosis. It is a benign estrogen-dependent gynecological condition that affects 5%-10% of women who are of reproductive age. Endometriosis often affects the ovary and fallopian tubes, although it can also occur in nonpelvic areas. The most typical location for extra-pelvic endometriosis is the abdomen. Umbilical endometriosis is a rare condition accounting for 0.5%-1.0% of all cases of endometriosis. In 3% of cases, there is a chance of malignant change. This disorder's precise etiology is uncertain. Recurrent discomfort and swelling around the umbilicus are the classic manifestations. In this instance, we describe a patient with primary umbilical endometriosis (PUE) who had cyclical bleeding and swelling over the umbilicus and was surgically naive. This case will demonstrate how, particularly in surgically naïve instances, diagnosis of PUE is frequently delayed due to ignorance of the entity.

A surgical case report on primary umbilical endometriosis (Villar's nodule).

Endometriosis is a disease characterized by the implantation of endometrial-like tissue outside the uterine cavity. Common symptoms include cyclical pain, dysmenorrhea, dyspareunia, and infertility. Although endometriosis can spread to various extrauterine locations including the ovaries, fallopian tubes, and peritoneal surfaces, umbilical endometriosis is a rare manifestation of the disease. We report an intriguing clinical case of primary umbilical endometriosis in a 36-year-old female patient admitted to our department due to the notable manifestation of a painful swelling at the umbilicus, accompanied by cyclic episodes of bleeding. Subsequent investigations, incorporating ultrasound and computed tomography, indicated the presence of umbilical endometriosis, a finding that was subsequently confirmed by pathological examination of a mass biopsy. Surgical resection of the umbilical mass was performed, and histopathological analysis definitively confirmed the diagnosis of endometriosis. This case report aims to discuss in depth the diagnosis and management of umbilical endometriosis.

Atypical umbilical endometriosis: Microscopic and immunohistochemical characterization / Endometriosis atípica umbilical. Caracterización microscópica e inmunohistoquímica

Introduction: Atypical endometriosis is considered a precursor lesion to cancer associated with endometriosis. Two types of atypical endometriosis have been proposed: an architectural type with a higher risk of malignancy and a cytological type with a lower potential for malignancy. Main symptoms and/or clinical findings: A 37-year-old Caucasian woman presented with umbilical bleeding coinciding with menstruation. On physical examination, two small, bluish lesions were observed in the umbilical scar. Primary diagnosis: This clinical case is of interest because it describes a lesion of atypical architectural endometriosis located in the navel. Therapeutic interventions and results: The microscopic and immunohistochemical characteristics of the lesion were examined. The presence of nuclear stratification, hyperchromatism, and pleomorphism were observed as microscopic qualities. In terms of the immunohistochemical panel, the degree of cell proliferation was analyzed using Ki 67, BAF250a was used as the surrogate marker of ARID 1A, inflammation was assessed through COX, and estrogen and progesterone receptors were examined. The results showed increased cellular activity, the presence of inflammation, and no mutation of the ARID1a gene, with moderate cell proliferation. Conclusion: Umbilical endometriosis is rare, and while malignancy is infrequent, it is possible. For this reason, a complete anatomopathological study including an immunohistochemical panel should be performed to diagnose atypical endometriosis.(AU)

Introducción: La endometriosis atípica está considerada como una lesión precursora de cáncer asociado a endometriosis. Se han propuesto 2 tipos de endometriosis atípica, una arquitectural con mayor riesgo de malignización y otra citológica cuyo potencial de malignización es menor. Principales síntomas y/o hallazgos clínicos: Una mujer de 37 años caucásica consulta por sangrado catamenial umbilical. A la exploración física se observan 2 pequeñas lesiones umbilicales azuladas. Diagnóstico principal: Este caso clínico es interesante porque se describe una lesión de endometriosis atípica arquitectural localizada en el ombligo. Intervenciones terapéuticas y resultados: Se ha descrito sus características microscópicas e inmunohistoquímicas para caracterizarla. La presencia de estratificación nuclear, hipercromatismo y pleomorfismo como cualidades microscópicas y en cuanto al panel inmunohistoquímico se ha analizado el grado de proliferación celular mediante el Ki-67, BAF250a como el marcador subrogado del ARID1A, el grado de inflamación mediante COX y los receptores estrogénicos y gestagénicos. Los resultados demuestran que tiene una actividad celular aumentada, presencia de inflamación y no mutación del gen ARID1A con moderación proliferación celular. Conclusión: La endometriosis umbilical es poco frecuente y su malignización, aunque rara es posible. Por esta razón, se debería realizar un estudio anatomopatológico completo que incluya un panel inmunohistoquímico en aras de diagnosticar endometriosis atípica.(AU)

Characterising umbilical abdominal wall endometriosis as a distinct subgroup of abdominal wall endometriosis - retrospective cohort study.

Abdominal wall endometriosis (AWE) is one of the rarest forms of endometriosis. Little is known about differences between umbilical AWE (U-AWE) and non-umbilical AWE (non-U-AWE) patients. This retrospective cohort study included patients treated for AWE at tertiary endometriosis centre between 2012 and 2020. Patients were divided into two groups - umbilical AWE and non-umbilical AWE.We identified 14 U-AWE and 45 non-U-AWE patients who mostly had lesions in caesarean section scar (38, 64.4%), rarely at other locations (7, 11.9%). Infertility rates for U-AWE patients and non-U-AWE patients were 57.1% and 17.8%, respectively. Concurrent or previous peritoneal endometriosis was noted in 85.7% of U-AWE and 24.4% of non-U- AWE patients. In addition, U-AWE patients and non-UAWE patients significantly differed in following: parity, number of previous caesarean sections, lesion size, prevalence of concurrent or previous deep infiltrating endometriosis, bleeding from abdominal wall, cyclic pain, continuous pain.Infertility and pelvic endometriosis were more prevalent in U-AWE patients. Our data suggests that U-AWE may be a specific marker for a patient highly prone to pelvic endometriosis and subsequent infertility. Findings suggests that clinician should consider comprehensive evaluation of U-AWE patients.

Villars nodule: An incidental finding with uterine fibroids and infertility-A case report.

Villar's nodule is a rare presentation of endometriosis. Only a few cases report coexistence with uterine fibroids and infertility. We report an incidental discovery of a bleeding umbilical lesion confirmed as Villar's nodule in a 37-year-old woman with primary infertility who presented for myomectomy on account of leiomyomas.

[Villar's nodule]. / Nodule de Villar.

Umbilical endometriosis is a rare manifestation, most often isolated, of endometriosis, accounting for 0,5-1 % of all cases. It can be primary or secondary following surgery. It usually presents as a solid, skin-colored, red or purple-black nodule, frequently associated with pain and/or perimenstrual bleeding. Because it has a potential for malignant transformation, the gold standard of treatment is surgical removal.

L'endométriose ombilicale, ou nodule de Villar, est une manifestation rare et le plus souvent isolée d'endométriose, survenant dans 0,5 à 1 % des cas. Elle peut être primaire ou secondaire à une intervention chirurgicale. Elle se manifeste habituellement par un nodule ferme, de couleur chair, rouge ou violet-noir, fréquemment associé à des douleurs et/ou des saignements péri-menstruels. Il existe un risque potentiel de transformation maligne, raison pour laquelle le traitement de première intention est l'exérèse chirurgicale.

Coexistence of Primary Umbilical Endometriosis and Endometrial Hyperplasia: A Case Report and Review of the Literature.

Background: Unusual ectopic growth of endometrial tissue in the umbilicus of a patient who has not undergone surgery is known as primary umbilical endometriosis. When a patient presents with an umbilical nodule, whether or not they have symptoms, it is critical to have a high index of suspicion. Case Summary: Here, we present a rare case of umbilical endometriosis with concurrent endometrial hyperplasia in a 40-year-old para II patient from Western Ethiopia. A total abdominal hysterectomy and umbilical nodule excision were performed under general anesthesia. After two months, she returned for a follow-up visit and was in good health. Conclusion: Primary umbilical endometriosis may coexist with endometrial hyperplasia. Hence, in order to provide suitable comprehensive management, a thorough gynecological evaluation is required.

Clinical and Surgical Characteristics of Abdominal Wall Endometriosis: A Multicenter Case Series of 80 Women.

BACKGROUND/AIM: Endometriosis of the abdominal wall (AWE) is poorly understood because of its rarity and heterogeneous nature. The aim of this study was to investigate and present the clinical and surgical characteristics of AWE and to propose its classification. PATIENTS AND METHODS: This was a multicentric retrospective study. For this analysis, the data from three endometriosis centers were collected. In total 80 patients were included in this study. The Academic Hospital Cologne Weyertal is a certified, level III endometriosis center in Germany with 750-1,000 endometriosis surgeries being performed annually; Barzilai University Medical Center is a certified endometriosis center in Ashkelon, Israel; and Baku Health Center is an endometriosis Center in Baku, Azerbaijan. RESULTS: The size of nodule (histological specimen) was significant larger in women with than those without adenomyosis (3.34±1.4 vs. 2.55±1.33 cm, p=0.016). The incidence of subfascial involvement was also found to be significantly higher in these women (42% vs. 19%, p=0.03). No significant difference was found in patients with and without obesity. In 78% of cases, the proliferation level (Ki67 marker) was less than 30%. CONCLUSION: AWE has a high prevalence of symptoms such as abdominal wall pain and swelling, as well as bleeding. The strengths of the current study are the investigation of the proliferation marker Ki67 in AWE, the impact of adenomyosis, as well as the suggested classification.

Clinical Features and Management of Umbilical Endometriosis: A 30 Years' Monocentric Retrospective Study.

INTRODUCTION: Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5-1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. MATERIAL AND METHODS: We retrospectively reviewed all cases of women diagnosed with UE in the period 1990-2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. RESULTS: A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. CONCLUSIONS: The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.

A Case of Primary Endometriosis Associated With an Umbilical Hernia.

Endometriosis is a common gynecological disease that mainly influences pelvic organs. However, extra-pelvic endometriosis is considered less prevalent. Here, we present a case study of umbilical endometriosis associated with an underlying hernia. It is known that the incidence of such a case is very rare and its diagnosis is challenging. Surgical excision of this type of lesion with a repair of the hernia is considered the preferred management approach. In this case, a 40-year-old female was admitted to the hospital with cyclical umbilical bleeding for one year. The bleeding would start with her menstruation and continue throughout the menstrual period. Initial diagnosis was made by physical examination and ultrasound imaging. Treatment options were discussed with her and she accepted to undergo surgical wide excision of the umbilical lesion with a repair of the hernia. Diagnosis was further confirmed by a histopathological study of the lesion tissue specimen. Also, a referral to a gynecologist did not report any abnormality or pelvic disease, and the patient was discharged well from the hospital.

Primary umbilical endometriosis presenting with umbilical bleeding: A case report.

Endometriosis is a condition in which endometrial tissue implants outside the uterine cavity, which can cause cyclic pain, dysmenorrhea, dyspareunia, and infertility. Endometriosis implants are typically seen on pelvic peritoneal surfaces and extra-pelvic disease is uncommon. We present an interesting case of primary umbilical endometriosis in a patient who presented with umbilical bleeding with a history of pelvic inflammatory disease complicated by bilateral tubo-ovarian abscesses. She was found to have an umbilical mass, which was resected, and the pathology was consistent with endometriosis. The objective of this case report is to detail the case and discuss diagnosis and management of umbilical endometriosis. It is important to recognize that umbilical endometriosis can occur in patients with no surgical history.

Comparative Analysis of Umbilical Nodules in Male and Female Patients: A 20-Year Retrospective Study / Análisis comparativo de los nódulos umbilicales en pacientes masculinos y femeninos: un estudio retrospectivo de 20 años

Background and aims The umbilicus is known to receive metastatic malignancy from diverse visceral organs. Accurate and correct diagnosis of umbilical lesions is imperative since metastatic malignancy signifies a serious underlying situation with dire prognosis. Identification of demographic features that can contribute to diagnostic resolution of umbilical lesions is desirable. We analyzed umbilical biopsies received over a 20-year period to determine any gender distinctive attributes of umbilical nodules. Materials and method All umbilical biopsies received in our department from 1st January 2000 to 31st December 2019 were identified and analyzed. Data acquired included patient's gender, age, date of biopsy, type of biopsy and histopathological diagnoses and these were analyzed using computer software. Results There were 67 umbilical biopsies from 22 males and 45 females giving a male: female ratio of 1:2. The difference between the mean age (SD) of male patients [47.8 years (19.4 years)] and that of the females [42.8 years (13.9 years)] was not statistically significant (p=0.28). Twenty-five of the 67 umbilical lesions were benign while 42 were malignant. About 90.9% of biopsies in males were malignant and 9.1% benign while 48.9% of biopsies in females were malignant and 51.1% benign. The odds of malignant umbilical biopsy in males compared to females is 10.5 [OR=10.5; 95% CI=2.2–50.1)]. Conclusion Umbilical biopsies were relatively infrequent in our practice and were more common in females than males. Umbilical lesions presented by males are mostly malignant. Overall, 78% of all umbilical lesions in females were of gynecological derivation (AU)

Antecedentes y objetivo Se sabe que en el ombligo se presentan metástasis de neoplasias de diversos órganos viscerales. Es imperativo el diagnóstico preciso y correcto de las lesiones umbilicales, ya que la caracterización metastásica implica una situación subyacente grave con un pronóstico nefasto. Es deseable la identificación de las características demográficas que pueden contribuir a la resolución diagnóstica de las lesiones umbilicales. Analizamos las biopsias umbilicales recibidas durante un período de 20 años para determinar los atributos distintivos de género de los nódulos umbilicales. Material y método Se identificaron y analizaron todas las biopsias umbilicales recibidas en nuestro departamento desde el 1 de enero de 2000 hasta el 31 de diciembre de 2019. Los datos adquiridos incluyeron el sexo del paciente, la edad, la fecha de la biopsia, el tipo de biopsia y los diagnósticos histopatológicos y se analizaron mediante un software informático. Resultados Hubo 67 biopsias umbilicales de 22 hombres y 45 mujeres dando una relación hombre: mujer de 1:2. La diferencia entre la edad media (DE) de los hombres [47,8 años (19,4 años)] y la de las mujeres [42,8 años (13,9 años)] no fue estadísticamente significativa (P=0,28). Veinticinco de las 67 lesiones umbilicales fueron benignas mientras que 42 fueron malignas. El 90,9% de las biopsias en hombres fueron malignas y el 9,1% benignas, mientras que el 48,9% de las biopsias en mujeres fueron malignas y el 51,1% benignas. El riesgo de que una biopsia umbilical fuera maligna en hombres en comparación con mujeres fue de 10,5 [RP=10,5; IC del 95%=2,2 a 50,1)]. Conclusión Las biopsias umbilicales fueron relativamente poco frecuentes en nuestra práctica y fueron más comunes en mujeres que en hombres. Las lesiones umbilicales que presentan los varones son en su mayoría malignas. En general, el 78% de todas las lesiones umbilicales en mujeres fueron de derivación ginecológica (AU)

[Artículo traducido] Análisis comparativo de los nódulos umbilicales en pacientes masculinos y femeninos: un estudio retrospectivo de 20 años / Comparative Analysis of Umbilical Nodules in Male and Female Patients: A 20-Year Retrospective Study

Antecedentes y objetivo Se sabe que en el ombligo se presentan metástasis de neoplasias de diversos órganos viscerales. Es imperativo el diagnóstico preciso y correcto de las lesiones umbilicales, ya que la caracterización metastásica implica una situación subyacente grave con un pronóstico nefasto. Es deseable la identificación de las características demográficas que pueden contribuir a la resolución diagnóstica de las lesiones umbilicales. Analizamos las biopsias umbilicales recibidas durante un periodo de 20 años para determinar los atributos distintivos de género de los nódulos umbilicales. Material y método Se identificaron y analizaron todas las biopsias umbilicales recibidas en nuestro departamento desde el 1 de enero del 2000 hasta el 31 de diciembre del 2019. Los datos adquiridos incluyeron el sexo del paciente, la edad, la fecha de la biopsia, el tipo de biopsia y los diagnósticos histopatológicos, y se analizaron mediante un software informático. Resultados Hubo 67 biopsias umbilicales de 22 hombres y 45 mujeres dando una relación hombre: mujer de 1:2. La diferencia entre la edad media (DE) de los hombres (47,8 años [19,4 años]) y la de las mujeres (42,8 años [13,9 años]) no fue estadísticamente significativa (p=0,28). Veinticinco de las 67 lesiones umbilicales fueron benignas, mientras que 42 fueron malignas. El 90,9% de las biopsias en hombres fueron malignas y el 9,1% benignas, mientras que el 48,9% de las biopsias en mujeres fueron malignas y el 51,1%, benignas. El riesgo de que una biopsia umbilical fuera maligna en hombres en comparación con mujeres fue de 10,5 (RP=10,5; IC del 95%=2,2 a 50,1). Conclusión Las biopsias umbilicales fueron relativamente poco frecuentes en nuestra práctica y fueron más comunes en mujeres que en hombres. Las lesiones umbilicales que presentan los varones son en su mayoría malignas. En general, el 78% de todas las lesiones umbilicales en mujeres fueron de derivación ginecológica (AU)

Background and aims The umbilicus is known to receive metastatic malignancy from diverse visceral organs. Accurate and correct diagnosis of umbilical lesions is imperative since metastatic malignancy signifies a serious underlying situation with dire prognosis. Identification of demographic features that can contribute to diagnostic resolution of umbilical lesions is desirable. We analyzed umbilical biopsies received over a 20-year period to determine any gender distinctive attributes of umbilical nodules. Materials and method All umbilical biopsies received in our department from 1st January 2000 to 31st December 2019 were identified and analyzed. Data acquired included patient's gender, age, date of biopsy, type of biopsy and histopathological diagnoses and these were analyzed using computer software. Results There were 67 umbilical biopsies from 22 males and 45 females giving a male: female ratio of 1:2. The difference between the mean age (SD) of male patients [47.8 years (19.4 years)] and that of the females [42.8 years (13.9 years)] was not statistically significant (P=0.28). Twenty-five of the 67 umbilical lesions were benign while 42 were malignant. About 90.9% of biopsies in males were malignant and 9.1% benign while 48.9% of biopsies in females were malignant and 51.1% benign. The odds of malignant umbilical biopsy in males compared to females is 10.5 [OR=10.5; 95% CI=2.2–50.1)]. Conclusion Umbilical biopsies were relatively infrequent in our practice and were more common in females than males. Umbilical lesions presented by males are mostly malignant. Overall, 78% of all umbilical lesions in females were of gynecological derivation (AU)

Coexistence of cutaneous endometriosis and ovarian endometrioma: a case report.

BACKGROUND: Umbilical endometriosis is a rare entity accounting for 0.5-4% of cases with endometriosis. CASE PRESENTATION: Here we report a rare case of umbilical endometriosis with concurrent ovarian endometriomas in a 37-year old primiparous Iranian woman. CONCLUSION: This interesting coexistence reflects the importance of thorough gynecological assessment in patients with cutaneous endometriosis to enable appropriate management.

Primary umbilical endometriosis coexisiting with multiple uterine fibroids: A case report.

INTRODUCTION: Uterine fibroids and endometriosis are independent causes of infertility/subfertility in women of reproductive age. Primary umbilical endometriosis is rare. PRESENTATION OF CASE: Here, we report a case of primary umbilical endometriosis coexisting with multiple uterine fibroids in a 35 year old nulliparous woman who presented with abdominal swelling as well as cyclical pain and swelling of the umbilicus without any previous surgery. She had abdominal myomectomy and excision of the umbilical lesion with histological confirmation of uterine fibroids and umbilical and peri-umbilical endometriosis. DISCUSSION: Primary umbilical endometriosis should be considered as a possible differential diagnosis in cases of umbilical disorders even if the patient has no typical symptoms of pelvic endometriosis. The clinical features include an umbilical swelling (90%), often associated with cyclical pain (81.5%) and bleeding or discharge (49.2%); while some patients may be asymptomatic. The diagnosis of umbilical endometriosis could be made based on clinical findings but histological confirmation is the gold standard for diagnosis. The definitive treatment for umbilical endometriosis is surgical excision. CONCLUSION: Although rare, primary umbilical endometriosis may coexist with uterine fibroids and should be suspected in women of reproductive age who complain of cyclical umbilical disorders in addition to abdominal swelling or other symptoms of uterine fibroids.

Primary Umbilical endometriosis - case series and review of clinical presentation, diagnosis and management.

INTRODUCTION: Umbilical endometriosis is the most common cutaneous form and is seen mostly secondary to surgical scar and rarely occurs as primary umbilical endometriosis. The objective of this retrospective case series evaluation is to report the presentation, diagnosis, and management of patients with primary umbilical endometriosis. PRESENTATION OF CASES: We present a retrospective, observational and descriptive review of cases presenting with primary umbilical endometriosis among Indian women managed in two private tertiary care centres between 2018 and 2020. Patients were assessed at the gynaecological outpatient department. We analysed age, parity, presenting symptoms and duration, associated symptoms, imaging, size of the lesion, associated pelvic endometriosis or any pelvic pathology, management, and histopathological diagnosis for confirmation in all four patients. DISCUSSION: The patients were aged between 25 and 31 years with an average of 28 years with no previous history of any abdominal surgeries. The mean duration of the symptoms presented in these cases was 25.5 months, with a range from 18 to 48 months. The diagnosis was made by clinical examination supported by imaging followed by complete surgical excision and confirmation on histopathology. CONCLUSION: Primary umbilical endometriosis is a rare disease with a limited number of cases reported in the literature and should be included in the differential diagnosis if women present with umbilical lesions with cyclical pain. Diagnosis is clinical but can be aided by high resolution imaging such as Ultrasound (US) and Magnetic Resonance Imaging (MRI). Complete surgical excision is the treatment of choice.

Comparative Analysis of Umbilical Nodules in Male and Female Patients: A 20-Year Retrospective Study.

BACKGROUND AND AIMS: The umbilicus is known to receive metastatic malignancy from diverse visceral organs. Accurate and correct diagnosis of umbilical lesions is imperative since metastatic malignancy signifies a serious underlying situation with dire prognosis. Identification of demographic features that can contribute to diagnostic resolution of umbilical lesions is desirable. We analyzed umbilical biopsies received over a 20-year period to determine any gender distinctive attributes of umbilical nodules. MATERIALS AND METHOD: All umbilical biopsies received in our department from 1st January 2000 to 31st December 2019 were identified and analyzed. Data acquired included patient's gender, age, date of biopsy, type of biopsy and histopathological diagnoses and these were analyzed using computer software. RESULTS: There were 67 umbilical biopsies from 22 males and 45 females giving a male: female ratio of 1:2. The difference between the mean age (SD) of male patients [47.8 years (19.4 years)] and that of the females [42.8 years (13.9 years)] was not statistically significant (p=0.28). Twenty-five of the 67 umbilical lesions were benign while 42 were malignant. About 90.9% of biopsies in males were malignant and 9.1% benign while 48.9% of biopsies in females were malignant and 51.1% benign. The odds of malignant umbilical biopsy in males compared to females is 10.5 [OR=10.5; 95% CI=2.2-50.1)]. CONCLUSION: Umbilical biopsies were relatively infrequent in our practice and were more common in females than males. Umbilical lesions presented by males are mostly malignant. Overall, 78% of all umbilical lesions in females were of gynecological derivation.

Umbilical Endometriosis: A Systematic Literature Review and Pathogenic Theory Proposal.

Umbilical endometriosis represents 30-40% of abdominal wall endometriosis and around 0.5-1.0% of all cases of endometriosis. The aim of this systematic review is to revisit the epidemiology, signs, and symptoms and to formulate a pathogenic theory based on literature data. We performed a systematic literature review using the PubMed and Embase databases from 1 January 1950 to 7 February 2021, according to the PRISMA guidelines. The review was registered at PROSPERO (CRD42021239670). Studies were selected if they reported original data on umbilical endometriosis nodule defined at histopathological examination and described as the presence of endometrial glands and/or stromal cells in the connective tissue. A total of 11 studies (10 retrospective and one prospective), and 14 case series were included in the present review. Overall, 232 umbilical endometriosis cases were reported, with the number per study ranging from 1 to 96. Umbilical endometriosis was observed in 76 (20.9%; 95% CI 17.1-25.4) of the women included in studies reporting information on the total number of cases of abdominal wall endometriosis. Umbilical endometriosis was considered a primary form in 68.4% (158/231, 95% CI 62.1-74.1) of cases. A history of endometriosis and previous abdominal surgery were reported in 37.9% (25/66, 95% CI 27.2-49.9) and 31.0% (72/232, 95% CI 25.4-37.3) of cases, respectively. Pain was described in 83% of the women (137/165, 95% CI 76.6-88.0), followed by catamenial symptoms in 83.5% (142/170, 95% CI, 77.2-88.4) and bleeding in 50.9% (89/175, 95% CI 43.5-58.2). In the 148 women followed for a period ranging from three to 92.5 months, seven (4.7%, 95% CI 2.3-9.4) recurrences were observed. The results of this analysis show that umbilical endometriosis represents about 20% of all the abdominal wall endometriotic lesions and that over two thirds of cases are primary umbilical endometriosis forms. Pain and catamenial symptoms are the most common complaints that suggest the diagnosis. Primary umbilical endometriosis may originate from implantation of regurgitated endometrial cells conveyed by the clockwise peritoneal circulation up to the right hemidiaphragm and funneled toward the umbilicus by the falciform and round liver ligaments.