A primary umbilical endometrioma in a 38-year-old woman: a case report

Karyn A. Goodman, Krista E. Goodman, Candance Wong, Martine A. Louis, G. Lee
In: International Surgery Journal · 2024 · vol. 11(12) , pp. 2090–2094 · doi:10.18203/2349-2902.isj20243551 · W4404773142
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This case report describes a 38-year-old woman with primary umbilical endometrioma presenting as an abdominal mass, highlighting the diagnostic challenges and need for awareness of rare endometriosis manifestations.

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This case report describes a 38-year-old woman presenting with abdominal pain and an umbilical mass that was initially suspected to be a hernia but was identified as a primary umbilical endometrioma via computed tomography and surgical excision. Pathologic frozen sections confirmed the diagnosis of endometriosis, highlighting the diagnostic challenges associated with rare extra-pelvic manifestations of the disease. The authors note that while both medical and surgical therapies are available for treatment, awareness of this condition is crucial for accurate differential diagnosis of umbilical masses. This paper is centrally about endometriosis — specifically a rare presentation known as a primary umbilical endometrioma or Villar’s nodule.

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Abstract

Primary umbilical endometriosis (UE) is a rare case of migration of endometrial tissue to a distant location. However, there are literature gaps surrounding this area of study and may be easily missed when forming differential diagnoses for umbilical masses. We report a case of primary UE in the setting of abdominal pain and umbilical mass. The patient is a 38-year-old female who was admitted for abdominal pain and an umbilical mass. An umbilical mass without evidence of an umbilical hernia was found on computed tomography of the abdomen and pelvis. The differential diagnosis of umbilical hernia was then introduced. Exploration and surgical excision were utilized. Pathologic frozen sections confirmed endometrioma. Both medical and surgical therapies may be used in treating UE. This case highlights the need for awareness of rare endometriosis manifestations and illustrates the diagnostic challenges when assessing for possible causes of umbilical mass. By adequately evaluating for causes such as UE, we can accurately treat it with medical and surgical therapies.
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A primary umbilical endometrioma in a 38-year-old woman: a case report DOI: https://doi.org/10.18203/2349-2902.isj20243551Keywords: Primary umbilical endometrioma, Umbilical mass, Endometriosis, Villar’s nodule, UEAbstract Primary umbilical endometriosis (UE) is a rare case of migration of endometrial tissue to a distant location. However, there are literature gaps surrounding this area of study and may be easily missed when forming differential diagnoses for umbilical masses. We report a case of primary UE in the setting of abdominal pain and umbilical mass. The patient is a 38-year-old female who was admitted for abdominal pain and an umbilical mass. An umbilical mass without evidence of an umbilical hernia was found on computed tomography of the abdomen and pelvis. The differential diagnosis of umbilical hernia was then introduced. Exploration and surgical excision were utilized. Pathologic frozen sections confirmed endometrioma. Both medical and surgical therapies may be used in treating UE. This case highlights the need for awareness of rare endometriosis manifestations and illustrates the diagnostic challenges when assessing for possible causes of umbilical mass. By adequately evaluating for causes such as UE, we can accurately treat it with medical and surgical therapies. Metrics References Home AW, Missmer SA, Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022;14(379):e070750. Yahaya JJ, Morgan ED, Abraham ZS. Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review. Ann Med Surg (Lond). 2023;85(4):1011-1014. Dridi D, Laura B, Agnese D, Francesca G, Caterina L, Massimiliano B, et al. Clinical features and management of umbilical endometriosis: A 30 years monocentric retrospective study. Int J Environ Res Public health. 2022;19(24):16754. Benedetto C, Cacozza D, De Sousa Costa D, Coloma Cruz A, Tessmann Zomer M, Cosma S, et al. Abdominal wall endometriosis: Report of 83 cases. Int J Gynecol Obstetr. 2022;159(2):530-6. Alibrahim H, Albattour M, Swed S, Sawaf B, Al-Janabi MAH. Primary umbilical cutaneous endometriosis: The first case report in Syria. Ann Med Surg. 2021;72:103-06 Rahman NA, Shope T. Cyclical bleeding troar site endometrioma without known history of endometriosis: case report and literature review. J Surg Case Rep. 2022;2022(11);rjac498. Goldberg JM, Bedaiwy MA. Recurrent umbilical endometriosis after laparoscopic treatment of minimal pelvic endometriosis: a case report. J Reprod Med. 2007;52(6):551-2. Leite GK, De Carvalho LFP, Korkes H, Guazzelli TF, Kenj G, De Toledo Viana A. Scar endometrioma following Obstetric Surgical Incisions: Retrospective study on 33 cases and review of the literature. Sao Paulo Med J. 2009;127(5):270-7. Jakraphan Y, Laohathai S. Concomitant umbilical endometriosis with catamenial pneumothorax: a case report. AME Case Rep. 2022;6:16. Yong-Hun K, Wegehaupt AK, Wingo MT. A woman with recurrent umbilical bleeding: a case report. J Med Case Rep. 2022;16(1):444. Porter J, Jacob E, Crystal Y, Cecilia N. Multifocal abdominal endometriosis, a case report. J Surgical Case Rep. 2020;6:rjaa120. Maharjan PB, Makaju R, Makaju S, Dhakal R, Lama B, Basnet D, et al. Endometriosis of Groin Mimicking Neoplasm. Kathmandu University Med J. 2021;19(73):152-4. Jouini W, Litaiem N, Zaimi Y, Mouelhi L, Debbeche R, Zeglaoui F. Omphalolith: An underdiagnosed entity. Clin Case Rep. 2022;10(10):e6443. Yahaya JJ, Morgan ED, Abraham ZS. Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review. Ann Med Surg (Lond). 2023;85(4):1011-4. Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature. J Radiol Case Rep. 2017;11(12):16-26. Chen H, Wang G, Wang X, Gao Y, Liang J, Wang J. Diagnostic value of susceptibility-weighted imaging for endometrioma: preliminary results from a retrospective analysis. Acta Radiol. 2022;63(7):976-81. Warshafsky C, Corran B, Glen P, Busca A, Singh SS. Management of a large umbilical endometrioma. Am J Obstet Gynecol. 2023;229(3):333-6. Nowak-Psiorz I, Ciećwież SM, Brodowska A, Starczewski A. Treatment of ovarian endometrial cysts in the context of recurrence and fertility. Adv Clin Exp Med. 2019;28(3):407-413. Maul LV, Morrision JE, Schollmeyer T, Alkatout I, Mettler L. Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS. 2014;18(3):e2014.00223. Hirata T, Koga K, Mari K, Shinya F, Kazuaki N, Fuminori T, et al. A national survey of umbilical endometriosis in Japan. J Minim Invasive Gynecol. 2020;279(1):80-7. Lee JH, Song JY, Yi KW, Lee SR, Lee DY, Shin JH, et al. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci. 2018;25(10):1515-22. Obata K, Naoko I, Gen O, Yoshiki I. Clear cell adenocarcinoma arising from umbilical endometriosis. J Obstetr Gynaecol Res. 2013;39(1):455-61.

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