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Aggiornamento Skin Endometriosis

del 26-02-2013

J Plast Reconstr Aesthet Surg. 2013 Jan 28. pii: S1748-6815(12)00744-9. doi: 10.1016/j.bjps.2012.12.024. [Epub ahead of print]

Scar endometriosis: A rare skin lesion presenting to the plastic surgeon.

Marsden NJ, Wilson-Jones N.


Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Morriston, Swansea SA6 6NL, UK. Electronic address: nick_marsden@hotmail.com.


Endometriosis is the presence or growth of endometrial tissue outside the uterus, most commonly affecting the ovaries, uterine ligaments and the peritoneum. Cutaneous endometriosis is much rarer, and is mostly found at the sites of surgical scars, such as laparoscopies, hysterectomies and caesarean sections. We present a rare case of scar endometriosis in a 33 year-old women presenting to the plastic surgeon as a possible skin malignancy and review the literature.

Angiogenesis. 2013 Jan 19. [Epub ahead of print]

Vascular endothelial growth factor C is increased in endometrium and promotes endothelial functions, vascular permeability and angiogenesis and growth of endometriosis.

Xu H, Zhang T, Man GC, May KE, Becker CM, Davis TN, Kung AL, Birsner AE, D’Amato RJ, Wong AW, Wang CC.


Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.


Endometriosis is an angiogenesis-dependent disease. Many studies demonstrated inhibition of angiogenesis leads to inhibition of endometriotic growth, however underlying mechanism is still not fully understood. Our previous study suggested vascular endothelial growth factor C (VEGF-C) as a target of anti-angiogenesis therapy for endometriosis. In this study, VEGF-C in endometrium and its role in angiogenesis of endometriosis were studied. Human endometrium were obtained from women with and without endometriosis for molecular studies. VEGF-A, VEGF-B, VEGF-C and VEGF-D mRNA and proteins in eutopic and ectopic endometrium were measured. Human endothelial cells were transfected with VEGF-C siRNA in vitro, effects of VEGF-C on endothelial cell migration, invasion and tube formation were investigated in vitro. Angiogenesis was inhibited in wild type mice, vascular permeability in dermal skin was determined in vivo. Transplanted endometrium were inhibited by VEGF-C siRNA in immunocompromised mice, development, growth and angiogenesis of the experimental endometriosis were compared in vivo. The results showed that VEGF-C mRNA and protein were increased in eutopic and ectopic endometrium of endometriosis patients. VEGF-C siRNA significantly inhibited endothelial cell migration and tube formation. VEGF-C siRNA significantly inhibited development and angiogenesis of the experimental endometriotic lesions in mice. Supplementation and over-expression of VEGF-C significantly reversed the inhibitory effects on the endothelial functions, vascular permeability and endometriotic growth. In conclusion, VEGF-C is increased in endometrium and it promotes endothelial functions, vascular permeability and development of experimental endometriosis. VEGF-C is important for angiogenesis in endometriosis.

Int J Gen Med. 2012;5:999-1002. doi: 10.2147/IJGM.S37302. Epub 2012 Dec 5.

Primary umbilical endometrioma: a rare case of spontaneous abdominal wall endometriosis.

Efremidou EI, Kouklakis G, Mitrakas A, Liratzopoulos N, Polychronidis ACh.


First Surgical Department, Medical School, Democritus University of Thrace, University Hospital of Alexandroupolis.


Umbilical endometrioma is a rare condition, with an estimated incidence of 0.5%-1% in all patients with endometrial ectopia. Spontaneous abdominal wall endometriosis is an even rarer and more unusual condition with unclear pathogenetic mechanisms. A 44-year-old parous woman presented with an umbilical skin lesion, and no history of bleeding from the umbilical mass or swelling in the umbilical area. The initial clinical diagnosis was granuloma, and excision was planned. Pathology examination revealed endometrial glands with mucinous-type metaplasia surrounded by a disintegrating mantle of endometrial stroma. Clinical examination and magnetic resonance imaging did not reveal pelvic endometriosis lesions, and given that the umbilical endometrioma was totally excised, no further treatment with hormonal therapy was proposed for the patient. Three years after excision, she was free of disease and no recurrence has been observed. Complete excision and histology is highly recommended for obtaining a definitive diagnosis and optimal treatment in spontaneous abdominal wall endometriosis.

Radiographics. 2012 Nov-Dec;32(7):2031-43. doi: 10.1148/rg.327125024.

Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics.

Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, Katz DS.


Department of Radiology, Winthrop-University Hospital, 259 First St, Mineola, NY 11501, USA. rgidwaney@gmail.com


Implantation of an endometriotic lesion within a pelvic or abdominal wall scar is an uncommon but well-described condition that may be the underlying cause of acute or chronic recurrent abdominal or pelvic pain, especially after cesarean section. Radiologists may not consider scar endometriosis when it is encountered at cross-sectional imaging. Cesarean section scars are the most common site of extraovarian or extrauterine endometriosis. The condition also has been identified in other uterine surgery-related scars and in the skin, subcutaneous tissues, and abdominal and pelvic wall musculature adjacent to these scars. The most plausible cause of scar endometriosis is implantation of endometrial stem cells at the surgical site at the time of uterine surgery. Patients with scar endometriosis may be asymptomatic or present with cyclical pain corresponding to the menstrual cycle. Cross-sectional imaging findings vary from the nonspecific to those suggestive of the diagnosis when combined with clinical history. In particular, the presence of blood products in an anterior abdominal wall mass at magnetic resonance (MR) imaging with no other explanation is strongly suggestive of scar endometriosis. Ultrasonography, computed tomography, and MR imaging may be used to depict an endometriotic lesion, exclude endometriosis, or provide evidence for an alternative diagnosis.

Med Arh. 2012;66(5):353-4.

Primary cutaneous umbilical endometriosis.

Kesici U, Yenisolak A, Kesici S, Siviloglu C.


Ministry of Health, Akcaabat Hackali Baba State Hospital, Department of General Surgery, Trabzon, Turkey. uqurkesici77@mynet.com



Primary umbilical endometriosis a rare case. It is mostly seen in women in the reproductive age group.


In this case report, a 38 year old woman is discussed who received antibiotherapy for omphalitis diagnosis established due to many complaints of umbilical secretion but who was diagnosed with primary umbilical endometriosis after histopathological examination.


Endometriosis must be certainly considered in differential diagnosis in especially inflammatory lesions resistant to noncyclic treatment, determined in umbilical region.

J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):129-30. doi: 10.1016/j.bjps.2012.05.012. Epub 2012 Jul 10.

Cutaneous endometriosis: a plastic surgery perspective.

Din AH, Verjee LS, Griffiths MA.


St Andrew’s Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, CM1 7ET, UK. asmatdin@hotmail.com


Cutaneous endometriosis is a rare skin pathology that may present to the gynaecologist, general surgeon, dermatologist, or plastic surgeon. It is often misdiagnosed due to its rarity and variable appearance. In the current literature recommendations for its management vary greatly. We present a case of cutaneous endometriosis presenting to a plastic surgery service, as well as a review of the literature. Cutaneous endometriosis should be considered as a differential in any female presenting with an umbilical lesion, and should be diagnosed histiologically following an excision biopsy with 2 mm margins.

J Cutan Pathol. 2012 Aug;39(8):777-80. doi: 10.1111/j.1600-0560.2012.01907.x. Epub 2012 Jul 5.

Cutaneous deciduosis: a report of two cases of an unusual pseudomalignancy.

Natale KE, Royer MC, Rush WL, Lupton GP.


Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. Kristen.Natale@med.navy.mil


Cutaneous deciduosis represents a rare manifestation of cutaneous endometriosis in which typical endometrial glands and stroma are morphologically and physiologically transformed under hormonal influence. The transformed glands and stroma usually take on the microscopic appearance of uterine decidua but may mimic malignancy. We describe two cases of cutaneous deciduosis that presented in the post-partum period, but biopsies were not performed until a much later date. The first lesion arose on the perineum of a 31-year-old female after vaginal delivery, but a biopsy was not performed until 6 years after presentation. The second lesion grew in a cesarean section scar of a 26-year-old female with a history of ovarian adnexal endometriosis. Clinically described as a persistent post-operative hematoma, the lesion throbbed in synchrony with her menstrual cycles; a biopsy was also performed 6 years after presentation. Histopathologically, both specimens showed similar findings. Sections showed a multinodular proliferation of pale-staining epithelioid cells without significant nuclear atypia or conspicuous mitotic figures. Both showed focal glands that ranged from slit-like to slightly dilated and that contained a flattened epithelial lining without atypia. These unusual cases are presented to instruct about the pathologic findings of this entity in order to prevent the unnecessary diagnosis of malignancy.

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