Pathogenesis, Diagnosis, and Management of Inguinal Endometriosis: A Case Series of Six Patients

Saki Takatsuka, Hisashi Kataoka, Fumitake Ito, Koki Shimura, Taisuke Mori
Reproductive sciences (Thousand Oaks, Calif.) · 2025 · vol. 32(3) , pp. 647–654 · doi:10.1007/s43032-025-01796-9 · PMID:39856458 · W4406794999
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This case series reviewed six inguinal endometriosis patients, suggesting intravascular spread from the uterus, T1 hyperintensities on MRI, and effective dienogest treatment for lesions and pain.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This retrospective case series reviewed the pathogenesis, imaging findings, and management of six patients with inguinal endometriosis treated at a single facility from 2009 to 2019. The authors describe a hypothesized origin involving hematogenous/lymphogenous extension or direct infiltration, but in their cases they suggest possible intravascular spread from the uterine cavity; lesions appeared as nodular or pointed T1 hyperintensities on MRI, and all patients reported inguinal swelling and pain that worsened during menstruation. Complete surgical resection was used in some patients, while those who did not undergo surgery (or to prevent recurrence) received hormonal therapy, with dienogest reported as effective for reducing lesions, improving pain, and preventing recurrence, though the study’s small size and retrospective, single-center design are implicit limitations. This paper is centrally about endometriosis — specifically inguinal endometriosis and its proposed pathogenesis, MRI diagnosis, and dienogest-based management.

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Abstract

Inguinal endometriosis is a less common form of endometriosis. Therefore, there is no consensus regarding its pathogenesis or treatment. In this study, we retrospectively reviewed the pathogenesis and treatment of six cases of inguinal endometriosis in our facility between 2009 and 2019. The pathogenesis of inguinal endometriosis is believed to involve hematogenous and lymphogenous extensions, as well as direct infiltration from the canal of Nuck or inguinal hernia. However, in our cases, the endometriotic lesions might have spread intravascularly from the uterine cavity. The lesions in our all cases were found as nodular or pointed hyperintensities on T1-weighted magnetic resonance imaging. In addition, all the patients experienced swelling and pain in the inguinal region during menstruation. Complete resection is often performed; however, hormonal therapy is administered to patients who do not undergo surgery, or to avoid recurrence. In our cases, dienogest was effective in reducing inguinal endometriotic lesions, improving pain, and preventing recurrence. Similar content being viewed by others Data Availability Data is available from the authors upon reasonable request. Code Availability Not applicable.

References

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Acknowledgements

We thank all the study participants and Kyoto prefectural University of Medicine clinicians for their assistance. Funding No funding was involved with this study. Author information Authors and Affiliations Contributions ST: Writing – original draft. HK: Writing – review & editing, Writing – original draft, Conceptualization, Supervision. FI: Investigation, Writing – original draft. KS: Investigation, Writing—original draft. TM: Writing – review & editing, Supervision. Corresponding author Ethics declarations Ethics Approval This study was approved by the Institutional Review Board of Kyoto Prefectural University of Medicine on July 12, 2024. Approval number: ERB-C-3205. Consent to Participate All participants gave informed consent. Consent for Publication Consent was given by all the authors. Conflict of Interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Takatsuka, S., Kataoka, H., Ito, F. et al. Pathogenesis, Diagnosis, and Management of Inguinal Endometriosis: A Case Series of Six Patients. Reprod. Sci. 32, 647–654 (2025). https://doi.org/10.1007/s43032-025-01796-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-025-01796-9

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mesh:D004715endometriosis

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Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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