Abdominal wall endometrioma as rare differential diagnosis of a soft-tissue tumor

Abstract

Introduction: Endometriosis is characterized by the location of normal endometrial tissue, glands, and stroma,
outside the uterine cavity. Its frequency ranges from 3 to 15% of women of childbearing age. The most
common location is intra-abdominal, but it can also be extra-pelvic. Extra-pelvic endometriosis is infrequent
and is classified, according to its location, into four types: gastrointestinal, urinary tract, thoracic and "other
sites", in the form of painful nodules on the abdominal wall and scars from previous surgical interventions,
mainly gynecological or obstetric or as inguinal or umbilical nodules. The prevalence of localized
endometriosis in the abdominal scar after surgery ranges from 0.1 to 0.4%.

Objective: Describe a clinical case of endometriosis infrequently located in the abdominal wall.

Material and methods: Descriptive, retrospective study, presentation of a clinical case at the "IESS Latacunga
Basic Hospital", a case that was treated in the General Surgery service of the hospital.

Results: Description of the clinical case: a 68-year-old female patient with a personal clinical history of type 2
diabetes mellitus, non-insulin dependent, being controlled with oral hypoglycemic agents; high blood pressure
diagnosed 30 years ago in treatment; allergies: does not refer; surgical history: pelviperitonitis due to abscess
of the left ovarian tube, umbilical hernia and ectopic pregnancy. Current disease: Patient reported that
approximately 5 months ago he presented a mass in the umbilical region, of progressive growth, painful on
physical exertion, of low to moderate intensity without other accompanying symptoms, which is why he went
to the doctor, who decided to perform an echo of soft parts where reported: in the mesogastrium region
anechoic image of defined edges with echogenic mural and other central areas, avascular to the Doppler,
measures 13.06 x 9.78 x 7.56 cm; Due to its size, it is not possible to identify a dependency body. Reason for
which she went to the IESS Latacunga Hospital where she was admitted to the General Surgery Service, a
simple and contrasted Computerized Axial Tomography of the Abdomen and pelvis was performed, the same
that was reported: in the anterior abdominal wall at the level of the mesogastrium and hypogastrium in the
midline, in the thickness of the deep portion of the subcutaneous cellular tissue, hypodense, liquid-density
image measuring approximately 14 cm in diameter and having a volume of approx. 690 ml. Tumor markers
were requested: embryonal carcinogen antigen (CEA): 1.58 ng / ml, CA-125: 9 U / ml, CA19-9: 9.10 U / ml,
AFP alphafetoprotein: 0.67 ng / ml. After presenting the case to all the Staff of the General Surgery Service,
its surgical resection is decided.

Conclusions: Considering that the incidence of endometriomas of the abdominal wall is low, before any nodule with abnormal characteristics in the inguinal or umbilical region, or a tumor on a gynecological or

obstetric scar in a woman of fertile age, it is important to consider and suspect the presence of an
endometrioma. Imaging methods and fine needle aspiration-puncture can aid diagnosis and its definitive
treatment is surgical.