Endometriosis Case Study

INTRODUCTION

Endometriosis is the term used for the occurrence of endometrial tissue outside the uterus and is a major cause of pelvic pain and subfertility.[1] Cervix, vagina, vulva, rectovaginal septum, ovary, fallopian tubes, uterine ligaments, appendix, small and large bowel, bladder and ureters, pelvic peritoneum, hernia sacs, lymph nodes, kidney, skin, and even within skeletal muscles, peripheral nerves, pleura, lung, nasal cavity can be involved by endometriosis.[1] Microscopically endometrial glands and stroma are seen, often embedded in a dense fibrous mass exhibiting signs of fresh and old hemorrhage.[1] Most cases of the abdominal wall endometriosis occur spontaneously following the gynaecologic or obstetric surgery.[2] It affects

Patient gave past history of caesarean section 2 years back. On palpation it was tiny nodule, measuring about 3×2 cm, left side of the caesarean section scar. There was corresponding fluctuation in the size of the swelling during each cycle. The clinical diagnosis of scar endometriosis was made. FNAC smears show monolayered sheets and loosely cohesive clusters of polygonal to oval epithelial cells with bland chromatin, moderate amount of cytoplasm and inconspicuous nucleoli. Occasional cytoplasmic vacuolations were seen. Few clusters of fragments of spindle cells with moderate amount of cytoplasm and elongated nuclei were also seen. Background showed scattered hemosiderin laden

In present case patient`s age was 30 years and gave past history of caesarean section. 445 cases of abdominal wall endometriosis were reviewed by horton et al and observed that 57% and 11% cases showed endometriosis in the scars of caesarean section and hysterectomy respectively.[8] Pathan et al and Blanco et al also observed that scar endometriosis was more common in caesarean scar than hysterectomy scar.[7,8,] The lump at scar site, pain, fluctuation in size, bleeding and cyclical nature of symptoms during menstruation are the main clinical presentations of scar endometriosis.[3-10] The cyclical nature of symptoms is pathognomonic however may not be seen in all cases.[3-10] The imaging techniques are nonspecific however ultrasonography of abdominal wall endometriosis may show cystic, multicystic, mixed, or solid