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1
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Rzewuska N, Kunicki M, Mechsner S, Kordowitzki P. Rare Clinical Presentation of Postmenopausal Endometriosis: A New Perspective. Aging Dis 2023; 15:2361-2368. [PMID: 37962456 PMCID: PMC11567256 DOI: 10.14336/ad.2023.1022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Endometriosis affects 2-5 % of postmenopausal women with menopause hormone therapy and is less common in women without treatment with exogenous estrogen or tamoxifen. Postmenopausal endometriosis has more unknown aspects in its pathogenesis and clinical manifestation than in the case of premenopausal patients. The aim of this review was to summarize the clinical presentation of rare cases of endometriosis, including deep infiltrating (DIE) and extragenital endometriosis, in women. The symptoms of endometriosis in the post-reproductive age are more heterogeneous than in women of childbearing age, often resembling symptoms of gastrointestinal tumors or urinary tract diseases. We summarize cases of endometriosis of the intestines, liver, pancreas, and stomach, as well as endometriosis of the urinary tract and skin, with non-gynecological manifestations. We also describe the pathogenesis of endometrial tissue activity in the context of reduced estrogen levels after menopause, which is also not clear, and demands more molecular and genetic studies. NAD+-dependent deacetylases called Sirtuins are metabolic sensors for maintaining body homeostasis. In the context of endometriosis, Sirtuins are being studied for their potential role in modulating inflammation, cell proliferation, and sex hormone sensitivity, but their role in postmenopausal endometriosis is not well researched. Treatment in postmenopausal women includes mostly for now surgery, depending on the location of the lesion, and aromatase inhibitors. The complete genetic and epigenetic profile in women post-reproductive age is needed to propose target therapy, especially in severe cases such as endometriosis that is deeply infiltrating and located outside the pelvis.
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Affiliation(s)
- Natalia Rzewuska
- Department of Gynecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland.
| | - Michał Kunicki
- Department of Gynecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland.
- INVICTA Fertility and Reproductive Center, 00-019 Warsaw, Poland.
| | - Sylvia Mechsner
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Endometriosis Centre Charité, Department of Gynaecology, 13353 Berlin, Germany.
| | - Pawel Kordowitzki
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Endometriosis Centre Charité, Department of Gynaecology, 13353 Berlin, Germany.
- Department of Basic and Preclinical Sciences, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100 Torun, Poland
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2
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Prodromidou A, Machairas N, Paspala A, Hasemaki N, Sotiropoulos GC. Diagnosis, surgical treatment and postoperative outcomes of hepatic endometriosis: A systematic review. Ann Hepatol 2021; 19:17-23. [PMID: 31630985 DOI: 10.1016/j.aohep.2019.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 02/04/2023]
Abstract
Endometriosis is characterized by the presence of endometrial-like tissue and stroma in extra-uterine locations. Hepatic endometriosis (HE) is one of the rarest forms of extrapelvic endometriosis. We aimed to summarize the existing evidence on HE with special consideration to natural history, diagnosis and surgical treatment. Three electronic databases were systematically searched for articles published up to March 2019. All appropriate observational studies and case reports addressing cases of women with HE were considered eligible for inclusion. A total of 27 studies which comprised 32 patients with HE were included. Mean age of patients was 39.7 years. Ten (62.5%) were nulliparous and 24 (75%) were women of reproductive age. Eleven patients (36.7%) had a history of pelvic endometriosis of various sites. Abdominal pain was the primary symptom in 28 patients (87.5%). Preoperative diagnosis of endometriosis was available for 5 patients and 6 underwent a preoperative diagnostic procedure. Cyst resection, minor and major liver resections were performed in 14/31, 9/31 and 8/31 patients, respectively. Preoperative diagnosis of HE is challenging due to variable radiologic features and clinical symptomatology. Nonetheless, it should be considered in the differential diagnosis of a liver mass especially in premenopausal women with a history of endometriosis. The type of resection of the endometriotic lesion is based on the extent and the location of the disease and presented with favourable outcomes concerning morbidity, symptom relief and recurrence.
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Affiliation(s)
- Anastasia Prodromidou
- Department of Surgery, Division of Surgical Oncology, "Metaxa" Memorial Cancer Hospital, Piraeus, Greece.
| | - Nikolaos Machairas
- Third Department of Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anna Paspala
- Third Department of Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Natasha Hasemaki
- First Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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3
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Abstract
Endometriosis is a relatively common condition in which endometrial tissue is established in locations outside the uterus where, like the eutopic endometrium, it responds to hormonal stimuli and develops internal bleeding, inflammation, and fibrosis. These changes are associated with chronic and often debilitating cyclic pain and infertility. The pathogenesis of endometriosis is multifactorial, and several theories have been proposed to explain it. These include retrograde menstruation, celomic metaplasia, embryologic rests, and lymphovascular spread. Hormones, immunologic status, and genetic factors may also play a role. In most patients, the disease involves pelvic organs, but rarely it may also extend to a large variety of distant locations in the body. Patients with ovarian endometriosis are at higher risk for developing ovarian carcinomas including endometrioid and clear cell carcinomas. Some of these carcinomas may arise in a background of structural and/or nuclear atypia within the endometriotic foci. There is no known cure for endometriosis and treatment mostly consists of managing chronic pain or infertility.
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Affiliation(s)
- Maria Arafah
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - Sameera Rashid
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Akhtar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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4
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Eychenne C, Suc B, Delchier MC, Vidal F, Rimailho J, Illac C, Breibach F, Vaysse C, Chantalat E. Hepatic pedicle endometriosis: Case report and review of the literature. J Obstet Gynaecol Res 2019; 45:2121-2127. [PMID: 31368157 DOI: 10.1111/jog.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Abstract
The localization of endometriotic disease in the hepatic pedicle has never been reported to date. We report the first case of a 67-year-old postmenopausal patient having presented an endometriotic lesion in the hepatic pedicle. A surgical biopsy was needed to confirm the diagnosis after a first radiologic biopsy that concluded the presence of a mucinous cystic tumor with low-grade dysplasia. Medical treatment with aromatase inhibitors was carried out because of the inextirpable nature of the lesion. The diagnosis and therapeutic management of this rarely occurring lesion of atypical localization in a postmenopausal patient is presented here. A review of the literature on this localization could have led to a damaging surgical treatment due to the different diagnoses suggested. Management of endometriosis relies on a multidisciplinary approach that each practitioner must know how to broach with patients of all ages.
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Affiliation(s)
- Camille Eychenne
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
| | - Bertrand Suc
- Department of Visceral Surgery, CHU Rangueil, Toulouse, France
| | | | - Fabien Vidal
- Department of Gynecological Obstetric, CHU Paule de Viguier, Toulouse, France
| | - Jacques Rimailho
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
| | - Claire Illac
- Department of Pathology, IUCT-Oncopole, Toulouse, France
| | | | - Charlotte Vaysse
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
| | - Elodie Chantalat
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
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5
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Yamamoto R, Konagaya K, Iijima H, Kashiwagi H, Hashimoto M, Shindo A, Sasaki Y, Yamamoto K, Nakagawa M, Suno Y, Abe T, Takaki M, Suda K, Watanabe K. A Rare Case of Pancreatic Endometrial Cyst and Review of the Literature. Intern Med 2019; 58:1097-1101. [PMID: 30568111 PMCID: PMC6522422 DOI: 10.2169/internalmedicine.1702-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are extremely rare lesions that are difficult to diagnose before surgery. We report the case of a 26-year-old patient with a recent episode of left abdominal pain who presented with a large cyst in the pancreatic body. Laboratory results showed white blood cell and C-reactive protein elevation, whereas the patient's tumor marker levels were within the normal range. Distal pancreatectomy with splenectomy was performed. The final histopathological examination confirmed the presence of endometriotic cysts within the pancreas. Only 13 cases of endometriotic cysts of the pancreas have been previously reported. The preoperative diagnosis is challenging, and most patients undergo pancreatic resection because of suspected neoplasms. This case report reviews previous studies and discusses the clinicopathological features, pathogenesis, and appropriate treatment for pancreatic endometrial cysts.
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Affiliation(s)
- Ryuichi Yamamoto
- Department of Gastroenterology, Tokyo-west Tokushukai Hospital, Japan
| | | | - Hirokazu Iijima
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | - Hiroyuki Kashiwagi
- Department of Hepato-Biliary-Pancreatic Surgery, Shonan Kamakura General Hospital, Japan
| | | | - Asumi Shindo
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | - Yuki Sasaki
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | - Kota Yamamoto
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | | | - Yuma Suno
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | - Toshiyuki Abe
- Department of Gastroenterology, Saitama Sekishinkai Hospital, Japan
| | - Mutsuo Takaki
- Department of Surgery, Tokyo-west Tokushukai Hospital, Japan
| | - Koichi Suda
- Department of Pathology, Tokyo-west Tokuhsukai Hospital, Japan
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6
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Mederos MA, Villafañe N, Dhingra S, Farinas C, McElhany A, Fisher WE, Van Buren II G. Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas. World J Gastroenterol 2017; 23:1113-1118. [PMID: 28246486 PMCID: PMC5311101 DOI: 10.3748/wjg.v23.i6.1113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16 cm × 12 cm × 4 cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.
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7
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De Riggi MA, Fusco F, Marino G, Izzo A. Giant endometrial cyst of the liver: a case report and review of the literature. G Chir 2017; 37:79-83. [PMID: 27381694 DOI: 10.11138/gchir/2016.37.2.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometriosis is a benign condition described as the presence of endometrial- like tissue found outside the uterine cavity. Hepatic endometriosis is one of the rarest localization of extrapelvic endometriosis, only 22 cases have been reported in the literature. The preoperative diagnosis of hepatic endometriosis is rather difficult because in about the half of the patient affected they had no history of endometriosis. Moreover radiological images reveal no characteristic findings for hepatic endometriosis. It is often described as cystic mass with or without solid component, difficult to distinguish from hepatic abscess, hematoma, cystoadenoma or malignant neoplasia. We report a case of a 27-year-old female with a large cystic mass involving the left lobe of the liver. The patient underwent laparoscopic exploration and converted to laparotomy for resection of giant hepatic endometriosis.
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8
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Subcapsular hepatic endometriosis: case report and review of the literature. Radiol Case Rep 2016; 11:303-308. [PMID: 27920849 PMCID: PMC5128359 DOI: 10.1016/j.radcr.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/13/2016] [Accepted: 08/12/2016] [Indexed: 11/21/2022] Open
Abstract
Hepatic endometriosis is a very rare medical condition characterized by the implantation of ectopic endometrial tissue within the hepatic parenchyma. Preoperative diagnosis is difficult via cross-sectional imaging and histopathologic evaluation remains the gold standard for diagnosis. We report a case of hepatic endometrioma in a 44-year-old woman with history of endometriosis. The literature is reviewed, and magnetic resonance imaging findings together with differential diagnosis of hepatic endometriosis are highlighted.
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9
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Plodeck V, Sommer U, Baretton GB, Aust DE, Laniado M, Hoffmann RT, Platzek I. A rare case of pancreatic endometriosis in a postmenopausal woman and review of the literature. Acta Radiol Open 2016; 5:2058460116669385. [PMID: 27733937 PMCID: PMC5040200 DOI: 10.1177/2058460116669385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/21/2016] [Indexed: 12/19/2022] Open
Abstract
Pancreatic endometriosis is very rare with only a few cases reported in the literature. The imaging features are non-specific and the definitive diagnosis is usually only established after surgery. We report on a 68-year-old woman with left upper quadrant pain who demonstrated a mass in the pancreatic tail on imaging. Laboratory results showed only mildly elevated liver enzymes, tumor markers were within the normal range. A left pancreatectomy was performed, frozen section suggesting a benign lesion, and final histopathology confirmed endometriotic cysts. A research of the literature found only eight reported cases of endometriotic cysts of the pancreas, with the majority affecting premenopausal women. Preoperative diagnosis is challenging and most patients undergo resection because of suspected neoplasm. Thorough diagnostic workup may help in avoiding extensive surgery and reduce postoperative complications.
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Affiliation(s)
- Verena Plodeck
- Institut und Poliklinik für Radiologische Diagnostik, Dresden, Germany
| | | | | | | | - Michael Laniado
- Institut und Poliklinik für Radiologische Diagnostik, Dresden, Germany
| | | | - Ivan Platzek
- Institut und Poliklinik für Radiologische Diagnostik, Dresden, Germany
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10
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Nuovo M, Bayani E, Gerold T, Leong M, Mir R. Endometrioid Cystadenofibroma Developing in Juxtahepatic Endometriosis. Int J Surg Pathol 2016. [DOI: 10.1177/106689699800600208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 32-year-old woman presented with acute right upper quadrant pain. A computerized tomogram disclosed a 15.5 cm multicystic mass in the subhepatic space adherent to the liver. A hepatic hydatid cyst and metastasis from an ovarian carcinoma were considered as possible diagnoses. Surgical removal led to a diagnosis of an endometrioid cystadenofibroma in conjunction with endometriosis. To our knowledge, this is the first report of an endometrioid cystadenofibroma arising in juxtahepatic endometriosis.
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Affiliation(s)
| | - Elaine Bayani
- Department of Pathology, Nassau County Medical Center, State University of New York at Stony Brook, NY
| | - Thomas Gerold
- Department of Surgery, Nassau County Medical Center, State University of New York at Stony Brook, NY
| | - Mary Leong
- Department of Obstetrics and Gynecology, Nassau County Medical Center, State University of New York at Stony Brook, NY
| | - Rabia Mir
- Department of Pathology, Nassau County Medical Center, State University of New York at Stony Brook, NY
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11
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Focal Liver Lesion Secondary to Endometriosis: Case Report and Literature Review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Hepatic endometriosis is a rare disorder, without preoperative imaging findings are unclear. A diagnosis of endometriosis in a heterogeneous cystic liver mass should be considered, especially in patients with known endometriosis. Case Report A 40-year-old female patient complaining of sporadic abdominal and pelvic pain, not related to the menstrual cycle and without previous history of endometriosis, underwent routine sonographic evaluation, which indicated a lesion in the right hepatic lobe, apparently solid-cystic to ultrasonography. Upon further investigation using computed tomography (CT) and magnetic resonance imaging (MRI), image patterns consistent with hemorrhagic spots were also found; however, without the characteristics compatible with the most common focal hepatic lesions. It was suggested a possible diagnosis of metastasis by tumor of unknown site, due to the presence of a heterogeneous and hypodense nodule in the paracolic gutter, right to the CT, and then established the correlation with the clinical condition. The histological analysis has found a liver endometriosis, and the patient was referred surgical treatment. Conclusions Based on the analysis of this case, the authors present a review of the cases of liver endometriosis described so far, exposing and comparing the most common clinical and image findings.
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12
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Liu K, Zhang W, Liu S, Dong B, Liu Y. Hepatic endometriosis: a rare case and review of the literature. Eur J Med Res 2015; 20:48. [PMID: 25886632 PMCID: PMC4389341 DOI: 10.1186/s40001-015-0137-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/17/2015] [Indexed: 11/16/2022] Open
Abstract
Hepatic endometriosis is one of the rarest disorders characterized by the presence of ectopic endometrium in the liver. To our knowledge, only 21 cases of hepatic endometrioma have been described in the medical literature. We report a case of a 36-year-old primiparous female with hepatic endometriosis forming a large cystic mass. The patient presented once with severe right quadrant pain as her only symptom and no history of endometriosis. Complete blood count and biochemical tests were normal. Abdominal ultrasonography and computed tomography scans suggested the presence of a 6.5 × 6.0 cm cystic mass in segment III of the liver. The mass was completely removed by local liver resection. The intraoperative frozen sections suggested a diagnosis of hepatic endometriosis. The diagnosis was confirmed through histological immunostaining without intrinsic abnormality. A preoperative diagnosis of hepatic endometriosis is made on the basis of considering the possibility in advance. Hepatic endometriosis should be considered in the differential diagnosis of a cystic liver mass despite conducting exhaustive investigations in the absence of characteristic clinical and radiological features. Histological examination is essential, and surgery remains the treatment of choice.
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Affiliation(s)
- Kai Liu
- Department of Hepatobiliary and Pancreatic Surgery, No.71 Xinmin Street, First Hospital, Jilin University, Changchun, 130021, China.
| | - Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, No.71 Xinmin Street, First Hospital, Jilin University, Changchun, 130021, China.
| | - Songyang Liu
- Department of Hepatobiliary and Pancreatic Surgery, No.71 Xinmin Street, First Hospital, Jilin University, Changchun, 130021, China.
| | - Bingfei Dong
- Department of Thyroid Surgery, No.71 Xinmin Street, First Hospital, Jilin University, Changchun, 130021, China.
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, No.71 Xinmin Street, First Hospital, Jilin University, Changchun, 130021, China.
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13
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Frequently Misdiagnosed Extrapelvic Endometriosis Lesions: Case Reports and Review of the Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extrapelvic endometriosis is a rare condition defined as the presence of endometriotic stroma and glands outside the pelvis and elsewhere in the body. The cervix, vagina, vulva, intestinal tract, urinary tract, diaphragm, abdominal wall, inguinal canal, thoracic cage and lungs, extremities and even the central and peripheral nervous system can be involved. Because extrapelvic endometriosis is located in unusual sites, it is often confused with other pathologic conditions. This can lead to a difficult and challenging diagnosis and management. In the presence of recurrent, cyclical and catamenial symptoms, extragenital endometriotic lesions should be suspected. The aim of our paper is to report 9 cases of rare locations of extrapelvic endometriosis and to provide a literature review.
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14
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Sopha SC, Rosado FGN, Smith JJ, Merchant NB, Shi C. Hepatic Uterus-Like Mass Misdiagnosed as Hepatic Abscess. Int J Surg Pathol 2014; 23:134-9. [DOI: 10.1177/1066896914534465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hepatic endometriosis/uterus-like mass is rare and may be overlooked during hepatic cyst workups. We report a case of uterus-like mass, misdiagnosed as hepatic abscess. Case Report: A 47-year-old woman developed abdominal pain and vomiting. Infectious colitis with hepatic abscess was diagnosed, and remained antibiotic-refractory. Fine-needle aspiration and core biopsies showed benign contents. The patient presented to our institution with symptoms and normal blood work. Laparoscopic excision demonstrated a 1.4-cm cyst composed of endometrial glands (estrogen receptor+ and progesterone receptor+) and stroma (CD10+) with smooth muscle actin (SMA+), arranged in an organoid fashion. The patient, status-post hysterectomy, had no history or symptoms of endometriosis. Conclusion. This rare case illustrates the merit of considering uterus-like mass/endometriosis in the differential diagnosis of antibiotic-refractory hepatic cysts. Cyst heterogeneity may confound needle biopsy. We report the first instance of a hepatic uterus-like mass, with a review of related entities, postulated histogenesis, and important clinical associations.
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Affiliation(s)
| | | | - J. J. Smith
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Chanjuan Shi
- Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Hsu M, Terris B, Wu TT, Zen Y, Eng HL, Huang WT, Yeh MM. Endometrial cysts within the liver: a rare entity and its differential diagnosis with mucinous cystic neoplasms of the liver. Hum Pathol 2013; 45:761-7. [PMID: 24491354 DOI: 10.1016/j.humpath.2013.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 01/07/2023]
Abstract
Endometrial cysts within the liver are rare but can present as diagnostic challenges on small biopsies or frozen sections and may mimic mucinous cystic neoplasms (MCN) of the liver. Five cases of endometrial cysts and 6 cases of MCNs within the liver were collected. The clinicopathological, imaging, and immunohistochemical features were systematically reviewed and compared. The average size of the endometrial cysts was 8.3 cm. Four patients had a prior pelvic operation and coexisting endometriosis at other sites. All 5 cases of endometrial cysts had positive ER staining within both the epithelium and the stroma. PR was also positive in both epithelial and stromal cells in 4 cases. Four cases had additional immunostains performed, which all showed cytokeratin 19 and cytokeratin 7 positivity (only in epithelium) and CD10 positivity (only in stroma). α-Inhibin and calretinin were negative for both the epithelium and the stroma in all 4 cases. All 6 MCN cases (mean size, 11.1 cm) had positive ER, PR, and α-inhibin staining only in the stroma. ER and PR were positive in both the epithelium and stromal cells in endometrial cysts, whereas they were positive only in the stromal cells of MCNs. The stromal cells were CD10 positive and α-inhibin negative in endometrial cysts as opposed to the opposite staining pattern in MCNs. Awareness of this distinct staining pattern and the possibility of endometrial cysts in the liver can lead to accurate diagnoses and appropriate treatment modalities.
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Affiliation(s)
- Maylee Hsu
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Benoit Terris
- Service d'Anatomie Pathologique, Hopital Cochin, University Paris Descartes, Paris 75014, France
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Yoh Zen
- Histopathology Section, Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Hock-Liew Eng
- Department of Pathology, Chang-Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Wan-Ting Huang
- Department of Pathology, Chang-Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Matthew M Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
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16
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Monrad-Hansen PW, Buanes T, Young VS, Langebrekke A, Qvigstad E. Endometriosis of the pancreas. J Minim Invasive Gynecol 2012; 19:521-523. [PMID: 22748958 DOI: 10.1016/j.jmig.2012.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/02/2012] [Accepted: 03/08/2012] [Indexed: 02/05/2023]
Abstract
Endometrial cyst of the pancreas was first described in 1984. The condition is extremely rare, and only a few case reports have been described. Herein we present a case report of a peripancreatic endometriosis cyst in a perimenopausal woman. Computed tomography, magnetic resonance imaging, and regression of the cyst during an observation period of a few months made the diagnosis most likely before laparoscopic surgery. Awareness of the condition, optimal preoperative imaging, and clinical features are discussed.
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Affiliation(s)
- Peter Wiel Monrad-Hansen
- Department of Gastrointestinal Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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17
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Watari H, Shibahara N, Ebisawa S, Nogami T, Fujimoto M, Hikiami H, Shimada Y. A Case of Hepatic Endometriosis with Periodic Right Upper Quadrant Pain. ACTA ACUST UNITED AC 2012; 101:3233-5. [DOI: 10.2169/naika.101.3233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hidetoshi Watari
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Naotoshi Shibahara
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Shigeru Ebisawa
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Tatsuya Nogami
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Makoto Fujimoto
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Hiroaki Hikiami
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
| | - Yutaka Shimada
- Department of Japanese Oriental Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama
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18
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Abstract
Endometriosis is found predominantly in women of childbearing age. The prevalence of endometriosis is difficult to determine accurately. Laparoscopy or surgery is required for the definitive diagnosis. The most common symptoms are dysmenorrhea, dyspareunia, and low back pain that worsen during menses. Endometriosis occurring shortly after menarche has been frequently reported. Endometriosis has been described in a few cases at the umbilicus, even without prior history of abdominal surgery. It has been described in various atypical sites such as the fallopian tubes, bowel, liver, thorax, and even in the extremities. The most commonly affected areas in decreasing order of frequency in the gastrointestinal tract are the recto-sigmoid colon, appendix, cecum, and distal ileum. The prevalence of appendiceal endometriosis is 2.8%. Malignant transformation is a well-described, although rare (<1% of cases), complication of endometriosis. Approximately 75% of these tumors arise from endometriosis of the ovary. Other less common sites include the rectovaginal septum, rectum, and sigmoid colon. Unopposed estrogens therapy may play a role in the development of such tumors. A more recent survey of 27 malignancies associated with endometriosis found that 17 (62%) were in the ovary, 3 (11%) in the vagina, 2 (7%) each in the fallopian tube or mesosalpinx, pelvic sidewall, and colon, and 1 (4%) in the parametrium. Two cases of cerebral endometriosis and a case of endometriosis presenting as a cystic mass in the cerebellar vermis has been described. Treatment for endometriosis can be expectant, medical, or surgical depending on the severity of symptoms and the patient's desire to maintain or restore fertility.
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Affiliation(s)
- Neha Agarwal
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi
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19
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Oishi M, Hashida H, Yuba Y, Takabayashi A. Pancreatic endometrial cyst: report of a case. Surg Today 2011; 41:1011-5. [PMID: 21748624 DOI: 10.1007/s00595-010-4400-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/10/2010] [Indexed: 11/30/2022]
Abstract
A pancreatic endometrial cyst is an extremely rare disease. Since 1984, only 7 cases have been reported, including the current case. A 35-year-old woman with a history of recurrent severe left upper abdominal pain of 3 months' duration was found to have a cyst in the pancreatic body on the diagnostic imaging findings. With a preoperative diagnosis of mucous cystic adenoma, she underwent a distal pancreatectomy. The histopathological examination of the specimen revealed a pancreatic endometrial cyst. She complained about severe periodic abdominal pain during the convalescence, without any surgical complications. This study reviews previous reports of pancreatic endometrial cysts, and also discusses the clinicopathological features, pathogenesis, and appropriate treatment for this disease.
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Affiliation(s)
- Masaharu Oishi
- Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
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20
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Oishi M, Hashida H, Yuba Y, Takabayashi A. Pancreatic endometrial cyst: report of a case. Surg Today 2011. [PMID: 21748624 DOI: 10.1007/200595-010-4400-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A pancreatic endometrial cyst is an extremely rare disease. Since 1984, only 7 cases have been reported, including the current case. A 35-year-old woman with a history of recurrent severe left upper abdominal pain of 3 months' duration was found to have a cyst in the pancreatic body on the diagnostic imaging findings. With a preoperative diagnosis of mucous cystic adenoma, she underwent a distal pancreatectomy. The histopathological examination of the specimen revealed a pancreatic endometrial cyst. She complained about severe periodic abdominal pain during the convalescence, without any surgical complications. This study reviews previous reports of pancreatic endometrial cysts, and also discusses the clinicopathological features, pathogenesis, and appropriate treatment for this disease.
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Affiliation(s)
- Masaharu Oishi
- Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
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21
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Asran M, Rashid A, Szklaruk J. Hepatic endometriosis mimicking metastatic disease: a case report and review of the literature. J Radiol Case Rep 2010; 4:26-31. [PMID: 22470699 DOI: 10.3941/jrcr.v4i11.589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endometriosis of the liver is an uncommon disease characterized by the presence of endometrial tissue in the liver. There are no pathognomonic radiological features for hepatic endometriosis and preoperative diagnosis is difficult by imaging. Most cases are diagnosed after surgery. We report atypical imaging features of hepatic endometriosis in a 61 year-old female that mimic metastatic disease to the liver. She was referred to our institution with a presumed diagnosis of metastatic neuroendocrine tumors to the liver. After imaging guided core biopsy and histologic and immunohistochemical analysis, the diagnosis of hepatic endometrial stromal proliferation was made. We review the literature and provide imaging features that may help in reaching the correct diagnosis of hepatic endometriosis.
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Affiliation(s)
- Mohamed Asran
- Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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22
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Case hepatic endometriosis: a continuing diagnostic dilemma. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2009; 2009:407206. [PMID: 19587832 PMCID: PMC2705982 DOI: 10.1155/2009/407206] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 05/17/2009] [Indexed: 11/17/2022]
Abstract
Background. Intraparenchymal endometriosis of liver is rare. It may present as liver tumour and the diagnosis is not usually established till after surgery.
Case Outline. A 48-year-old postmenopausal woman presented with right upper quadrant pain and a cystic liver mass. Liver function tests and tumour markers (αFP, CEA, CA 19-9, and CA 125) were normal. Radiological imaging (USS, CT and MRI) suggested a thick walled cystic mass involving segments IV and VIII with complex intracystic septations. Frozen section at operation suggested a benign cystadenoma. The cyst was enucleated using a CUSA (Cavitron ultrasonic aspirator). The final histology confirmed endometriosis.
Discussion. Eleven cases of hepatic endometrioma have been reported and only four in postmenopausal women. Preoperative diagnosis poses a challenge and so far none of the cases have been diagnosed preoperatively. Surgery remains the treatment of choice. Accurate diagnosis at time of operation may avoid extensive liver surgery and its associated morbidity.
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23
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Cadranel J. Acquired Conditions. TEXTBOOK OF HEPATOLOGY 2007:810-817. [DOI: 10.1002/9780470691861.ch8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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24
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Sánchez-Pérez B, Santoyo-Santoyo J, Suárez-Muñoz MA, Fernández-Aguilar JL, Aranda-Narváez JM, González-Sánchez A, de la Fuente-Perucho A. [Hepatic cystic endometriosis with malignant transformation]. Cir Esp 2006; 79:310-2. [PMID: 16753122 DOI: 10.1016/s0009-739x(06)70878-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endometriosis, defined as the presence of endometrial tissue outside the uterine cavity, is most frequently located in the pelvic organs. Hepatic endometriosis is extremely rare, and only 12 cases have previously been reported. A wide variety of symptoms have been described, from asymptomatic masses (incidental findings) to acute abdomen. The diagnostic method of choice is abdominal CT, which should always be used in the differential diagnosis of cystic liver masses. Because of the high percentage of malignant transformation, the first-line treatment is surgical resection with adequate safety margins. We report a case of in situ adenocarcinoma arising in a hepatic endometrioma, which was treated with right hepatectomy.
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25
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Kosmahl M, Pauser U, Anlauf M, Sipos B, Peters K, Lüttges J, Klöppel G. [Cystic pancreas tumors and their classification: features old and new]. DER PATHOLOGE 2005; 26:22-30. [PMID: 15624092 DOI: 10.1007/s00292-004-0734-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cystic tumors and tumor-like lesions of the pancreas are rare, but have attracted a great deal of attention because they are easily recognized with new imaging methods and, in contrast to ductal adenocarcinoma, they can usually be cured surgically. The increasing resection rate in recent years has also increased our knowledge of cystic pancreatic tumors by conspicuously enlarging their morphological spectrum. Known entities have been better characterized (i.e. solid pseudopapillary neoplasm, intraductal papillary mucinous neoplasm) and new ones described (serous oligocystic adenoma, mucinous non-neoplastic cyst, acinar cell cystadenoma and cystic hamartoma). This review discusses the most important cystic tumors and tumor-like lesions, presents a new classification, and summarizes the immunohistochemical differential diagnosis.
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Affiliation(s)
- M Kosmahl
- Institut für Allgemeine Pathologie, Universitätsklinikum Schleswig-Holstein--Campus Kiel, Michaelisstrasse 11, 24105 Kiel, Germany.
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26
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Nezhat C, Kazerooni T, Berker B, Lashay N, Fernandez S, Marziali M. Laparoscopic management of hepatic endometriosis: Report of two cases and review of the literature. J Minim Invasive Gynecol 2005; 12:196-200. [PMID: 15922974 DOI: 10.1016/j.jmig.2005.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 12/20/2004] [Indexed: 11/21/2022]
Abstract
Hepatic endometriosis is rare. Only 15 cases have been reported in the literature. All 15 were treated by laparotomy. We report two additional cases of hepatic endometriosis managed for the first time laparoscopically. Endometriosis is a progressive disease especially in women of reproductive age. One of the differential diagnoses of liver endometriosis is malignancy. Currently, there are no reports in the literature regarding complications arising from the progression of hepatic endometriosis. However, this lack of evidence does not deny its existence.
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Affiliation(s)
- Camran Nezhat
- Department of Special Minimally Invasive Surgery, Dept of Gyn/OB and Surgery, Stanford University Medical School, Palo Alto, California 94304, USA.
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27
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Carbone A, Prete FP, Sofo L, Alfieri S, Rotondi F, Zannoni GF, Doglietto GB. Morphological and immunohistochemical characterization of an endometriotic cyst of the liver: diagnostic approach to endometriosis. Histopathology 2004; 45:420-2. [PMID: 15469486 DOI: 10.1111/j.1365-2559.2004.01912.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Kouto Fichet G, Aubé C, Lebigot J, Pessaux P, Rousselet MC, Caron C. Kyste endométriosique hépatique. ACTA ACUST UNITED AC 2004; 85:124-7. [PMID: 15094626 DOI: 10.1016/s0221-0363(04)97558-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hepatic endometriosis is a rare cause of complex hepatic cyst. We describe its typical imaging features. Diagnosis can be suggested at imaging but histological confirmation is required. The treatment of suspected endometriotic cyst of the liver is surgical, and percutaneous management is contraindicated.
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29
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Tuech JJ, Rousselet MC, Boyer J, Descamps P, Arnaud JP, Ronceray J. Endometrial cyst of the liver: case report and review. Fertil Steril 2003; 79:1234-6. [PMID: 12738526 DOI: 10.1016/s0015-0282(03)00178-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe a patient with a large endometrial cyst of the liver and review the literature concerning these rare lesions. DESIGN Case report. SETTING University hospital. PATIENT(S) A 42-year-old nulligravid woman with a 22 x 24 x 30 cm cyst in the right lobe of the liver. INTERVENTION(S) Thorough exploration of the abdominal cavity revealed no evidence of endometrial implants elsewhere. A complete excision of the cyst was performed. MAIN OUTCOME MEASURE(S) Surgical specimen. RESULT(S) Histologic examination of the surgical specimen confirmed the diagnosis of endometriosis. CONCLUSION(S) Endometriosis should be included in the differential diagnosis list of a peripherally located cystic liver mass in women.
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Affiliation(s)
- Jean-Jacques Tuech
- Department of Digestive Surgery, Angers University Hospital, Angers, France.
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30
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Reid GD, Kowalski D, Cooper MJW, Kaloo P. Hepatic endometriosis: a case report and review of the literature. Aust N Z J Obstet Gynaecol 2003; 43:87-9. [PMID: 12755358 DOI: 10.1046/j.0004-8666.2003.00007.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Geoffrey D Reid
- Department of Obstetrics and Gynaecology, Division of Women's and Child Health, Liverpool Hospital, New South Wales, Australia.
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31
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Abstract
Pancreatic endometrial cyst is an extremely rare instance of ectopic endometriosis that was first described by Marchevsky in 1984. A 21-yr-old woman with a history of epigastric pain and weight loss was found to have a cystic lesion in the pancreas on CT-scan. Under the tentative diagnosis of a pancreatic cystic neoplasm, partial pancreatectomy was performed. Histopathological examination of the specimen revealed cystic endometriosis. The clinicopathological features of the lesion are discussed and literature concerning this extremely rare lesion is reviewed.
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Affiliation(s)
- Dong Soo Lee
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong Tae Baek
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Min Ahn
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | - Sok Won Han
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Sik Chung
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hee Sik Sun
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Doo Ho Park
- Departments of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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32
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Huang WT, Chen WJ, Chen CL, Cheng YF, Wang JH, Eng HL. Endometrial cyst of the liver: a case report and review of the literature. J Clin Pathol 2002; 55:715-7. [PMID: 12195007 PMCID: PMC1769761 DOI: 10.1136/jcp.55.9.715] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The occurrence of pelvic endometriosis is not uncommon but hepatic endometriosis is extremely rare. Only five such cases of hepatic endometriosis have been described in the literature. This report concerns another patient with hepatic endometriosis forming a large cystic mass. The clinicopathological features and the possible pathogenesis are discussed. Endometriosis should be considered in the differential diagnosis of a cystic liver mass, particularly in patients with known endometriosis.
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Affiliation(s)
- W-T Huang
- Department of Pathology, Chang Gung University and Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan
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33
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Jeanes AC, Murray D, Davidson B, Hamilton M, Watkinson AF. Case report: hepatic and retro-peritoneal endometriosis presenting as obstructive jaundice with ascites: a case report and review of the literature. Clin Radiol 2002; 57:226-9. [PMID: 11952319 DOI: 10.1053/crad.2001.0667] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A C Jeanes
- Department of Clinical Radiology, The Royal Free Hospital, Hampstead, London, UK
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34
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Abstract
BACKGROUND Endometriosis can occur in unusual sites, liver involvement being first described in 1986. Extra-uterine malignant transformation in endometriosis has been reported, occurring mainly in the ovary. Liver involvement with endometrial stromal sarcoma (ESS) has not been previously reported. CASE OUTLINE Two patients presenting with symptomatic liver masses related to endometriosis, who successfully underwent surgical intervention, are presented. CASE 1 A 31-year-old woman previously had been treated with hysterectomy and bilateral salpingoophorectomy for severe pelvic endometriosis. Six years later, she presented with malaise from bilobar liver involvement with endometrial deposits. She proceeded acutely to hilar obstruction with obstructive jaundice and portal vein thrombosis. CASE 2 A 59-year-old post-menopausal woman had earlier presented acutely from a ruptured mesenteric cyst, which showed features of endometrial stromal sarcoma (ESS). Two years later, she presented with symptoms from a large ESS occupying the right lobe. DISCUSSION Endometriosis per se, as well as malignant transformation into ESS can involve the liver.These should be considered in women with hepatic space occupying lesions of unknown etiology.
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Affiliation(s)
- AW Khan
- Department of Surgery, Royal Free HospitalLondonUK
| | - M Craig
- Department of Surgery, Royal Free HospitalLondonUK
| | | | - BR Davidson
- Department of Surgery, Royal Free HospitalLondonUK
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