Type:
Educational Exhibit
Keywords:
Neoplasia, Biopsy, Ultrasound-Colour Doppler, MR, CT, Pelvis, Genital / Reproductive system female, Abdomen
Authors:
J. Saad1, Y. M. Abdou2, F. Marrakchi3; 1Monastir, TN/TN, 2Nejran/SA, 3Monastir/TN
DOI:
10.1594/ecr2013/C-0798
Background
Endometriosis,
a disorder affecting as many as 5-10% of women of childbearing age,
is defined as the presence of functional endometrial glands and stroma outside the uterine cavity (1).
The extra pelvic implantation of endometrial tissue has been described in virtually every organ.
The abdominal wall is an uncommon site of extra pelvic endometriosis,
which usually develops in a previous surgical scar.
The prevalence of surgically proven endometriosis in scars was up to 1.6 % (2).
Endometriosis of the rectus abdominis muscle is an exceptional occurrence and only 21 cases,
wherein the endometrial focus is solely confined to within the body of the rectus abdominis muscle,
have been clearly described to date in the medical literature (3,
4).
Endometriosis of the rectus muscle abdominis may be difficult to diagnose; it is often mistaken both clinically and with diagnostic imaging for other abnormal conditions such as a suture granuloma,
an incisional hernia,
or primary or metastatic cancer (5).
Diagnosis requires high index of suspicion,
it should be considered in any women of childbearing age with a painful or tender abdominal wall mass,
even if not associated with a scar of prior operation.
A good surgical and gynecological history as well as appropriate imaging techniques and fine needle aspiration (FNA) or biopsy of the lesion will usually lead to a correct diagnosis.
We retrospectively analyzed 10 cases in which endometriosis was found solely in the rectus abdominis muscle and discuss the way of diagnosis and its management putting a focus on this rare disease that can be missed for long time before diagnosis and management.