Spontaneously developed, solitary endometriosis of the umbilicus

Shimpei Sato, Kaei Nasu, Naoko Iwanaga, Yuichi Furukawa, Harunobu Matsumoto, Hisashi Narahara
In: Journal of Endometriosis · 2012 · vol. 4(3) , pp. 117–121 · doi:10.5301/je.2012.9726 · W1994493846
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This study reports a case of spontaneously developed, solitary umbilical endometriosis successfully treated with local excision in a patient without a surgical scar.

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Abstract

Purpose Endometriosis of the umbilicus is rare, with the most common site being laparoscopy scars. We report here a case of spontaneously developed, solitary umbilical endometriosis, not associated with a surgical scar, that was successfully treated with local excision. Case A 44-year-old Japanese woman was admitted complaining of an umbilical mass with cyclic pain, associated with her menstrual cycle. She had noticed the umbilical pain six months earlier. She had not received an abdominal operation or hormonal treatment. Abdominal examination revealed an index-finger-tip-sized, dome-shaped, painful, subcutaneous mass beneath the umbilicus with slightly brownish skin. Gynecologic examination showed a fibroid uterus of double-fist size. Magnetic resonance imaging revealed a subcutaneous mass beneath the umbilicus 1.5 cm in diameter. The umbilical mass was revealed to be high intensity with a small low-intensity area by both T1-weighted and T2-weighted images, suggesting umbilical endometriosis. The patient was treated by local excision of the umbilical mass, and full excision was achieved. Total hysterectomy and right salpingo-oophorectomy were performed simultaneously to treat the uterine fibroid. The pathologic diagnosis of the excised umbilical tissue was endometriosis. Endometriotic or adenomyotic lesion was not detected in the resected uterine and tubo-ovarian tissues. Gonadotropin-releasing hormone antagonist administration for six months was commenced after the surgical treatment. The patient is doing well without evidence of disease four months after surgery. Conclusion Spontaneously developed umbilical endometriosis is rare. Simultaneous laparoscopy or laparotomy should be considered to assess co-existent pelvic endometriosis at the time of surgical treatment in selected cases.

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endometriosis

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