Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature

Posted By Madison Kocher
Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature

ABSTRACT: Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided. CASE: The patient was a 37-year-old G8P0444 female presenting with left lower abdominal pain that had been occurring intermittently for the past 6 months. The patient described the pain as burning in nature and that it became worse during menses. Her surgical history was significant for three prior Cesarean sections, the last of which was approximately four years ago. On physical exam, there was a palpable knot located in the lower abdominal wall just lateral and superior to the left extent of the pfannenstiel incision scar. Past medical history was otherwise only notable for diabetes type II and obesity. Figures 1 and 2: Axial and coronal images of the abdomen of a 37-year-old female with cyclical left lower abdominal pain and a palpable mass at the left extent of the pfannenstiel incision scar. A 3.2 x 2.8 cm subcutaneous soft tissue density was present (red oval). Figures 3 and 4: Axial and coronal images of the abdomen of the same patient 6 months prior who presented with vague abdominal pain and was imaged due to concern for uterolithiasis. A 2.5 x 2.3 cm subcutaneous mass was noted (red oval). Figure 5: Gross specimen of the resected endometrioma nodule recovered after surgical excision. The nodule measured approximately 3 cm in diameter. Figure 6: There are two un-oriented and disrupted pieces of yellow-brown, cauterized tissue measuring 2.9 x 2.2 x 1.2 cm and 3.3 x 2.4 x 1.4 cm. The surfaces are inked black. Sectioning revealed a red-white, hemorrhagic and mottled cut surface. Figure 7: Post-operative digital photograph following closure of anterior abdominal wall after complete excision of the endometroid nodule. The incision was made on the lateral and superior left extent of the pfannenstiel incision scar. Figures 8a, b, and c: Hemotoxylin and eosin-stained photomicrographs (a) 4X low power view of the scar with endometriosis (yellow arrow) and adjacent adipose tissue; (b) 10X view of endometriosis comprised of endometrial glands (denoted by *) and stroma (surrounding purple area denoted by a blue arrow) with associated blood and fibrin in fibrous scar; (c) 40x close up view of the endometrial glands with tubal metaplasia (denoted by *), sitting with adjacen

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