Primary umbilical endometriosis – A rare presentation of cutaneous endometriosis

Primary umbilical endometriosis is a rare condition with an overall incidence of around 0.5% to 1% among all the endometriosis cases, but at times it poses a diagnostic dilemma. In our institution we encountered a case of primary umbilical endometriosis presented to multiple surgical speciality departments. A prompt clinical examination with surgical biopsy was the key tool which lead to the diagnosis and providing a complete cure for the patient. Pelvic endometriosis affects 5-10% of women in the child bearing age group. The most pronounced symptoms are dyspareunia, pelvic pain, and infertility. Clinical presentations of umbilical endometriosis are as a nodule with or without associated umbilical pain and bleeding. This patient was given primary hormonal therapy and later underwent a biopsy which paved way for an accurate diagnosis of primary umbilical endometriosis. In this case of umbilical swelling, conditions like a benign nevus, lipoma, abscess, cyst, hernia, as well as metastatic deposit from a systemic malignancy were considered in the clinical differential diagnosis. However surgical excision helped us arrive at a definitive diagnosis and cure for the patient.

Painless umbilical nodule in a nulliparous female – A clinical quandary

Background: Endometriosis is a well-known entity most often found within the pelvis and extra pelvic sites like skin, diaphragm, gastrointestinal tract and brain. Primary umbilical endometriosis is a rare form of cutaneous endometriosis, typically presenting as a hyperpigmented umbilical nodule with or without cyclical pain. We present a case of painless umbilical nodule with discolouration in a nulliparous woman, unsuspected clinically with the diagnosis being made primarily on cytology. Case report: A forty-year old female presented with a painless, brownish discoloured umbilical nodule, which was present since two months, was irreducible and had a negative cough impulse. She had no prior surgeries. Ultrasonography of abdomen and pelvis revealed a hypodense lesion of 2cm in the umbilicus, suggesting a possibility of umbilical granuloma. Uterus showed leiomyomata. Cytological evaluation of the umbilical nodule was suggestive of endometriosis. The patient underwent hysterectomy for leiomyomata and omphalectomy. Histopathology confirmed the diagnosis of umbilical endometriosis supported by the immunohistochemistry marker (CD10) being positive for endometrial stromal cells. The uterus had adenomyotic foci in addition to leiomyomata. Conclusion: The clinical distinction between primary umbilical endometriosis and other causes of umbilical nodules is challenging. Imaging modalities do not show pathognomonic signs in establishing this diagnosis. A definitive diagnosis is possible on cytology based on classical morphological features with histopathological examination being the gold standard diagnostic modality.

Cutaneous Endometriosis: A Case Report

Cutaneous endometriosis (CEM) is a rare disease characterized by endometrial glands and/or stroma in the skin. Lesions present as a firm papule or nodule and can be blue, violaceous, red, brown or skin-colored. Patients frequently report cyclical tenderness, swelling and bleeding at the site of the lesion related to their menstrual cycle. CEM presents a diagnostic challenge as lesions are commonly mistaken for a keloid, dermatofibroma, dermatofibrosarcoma protuberans, melanoma or cutaneous metastasis of cancer (e.g., Sister Mary Joseph nodule). A biopsy must be taken to rule out malignancy and treatments include surgical excision and hormonal agents. To our knowledge, just over 100 cases have been reported in the literature. Herein we highlight a case of CEM in a 43-year-old female that presented to dermatology after being overlooked on prior work-up with obstetrics and gynecology. This case highlights the need for dermatologists to be familiar with CEM, as we may be the first clinicians these patients present to for painful cutaneous lesions.

Menstruating primary umbilicus cutaneous endometriosis: A case report and review of literature

Primary umbilical cutaneous endometriosis is a rare umbilical endometrioma that affects women who are within the reproductive age group. It may be associated with infertility and severe dysmenorrhea and can be difficult to diagnosed in an asymptomatic patient. We report a case of a 38-year-old nulliparous with seven years history of infertility and severe dysmenorrhea. Her hormonal profile assay and hysterosalpingogram results were normal while her husband semen analysis was also within normal range. She complained of monthly bleeding from a painful rubbery multilobate cutaneous nodule on the umbilicus of one year duration. She was diagnosed of cutaneous endometriosis. The diagnosis was confirmed histologically and she had surgical excision with good outcome.

Skin endometriosis at the caesarean section scar: a case report

Endometriosis is a pathology little referenced in the dermatological literature and is defined as the presence of endometrial tissue outside the uterus. When it is a well-defined mass of endometriosis it is called endometrioma. Cutaneous endometriosis is one of the rare gynecological conditions. Cutaneous endometriosis is a disorder that primarily affects women of reproductive age. The disorder is most commonly associated with cyclical pain during menses, but it can be difficult to diagnose in the absence of these symptoms and requires biopsy testing for a definitive diagnosis. We report on a case of a 39-year-old patient who presented with pain at the cearean section scar. She was ultimately diagnosed with cutaneous endometriosis and underwent surgical excision.