An umbilical bleeding nodule.
نویسندگان
چکیده
Shah H, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220470 Description A 23-year-old woman was referred to the dermatology department through the 2-week wait pathway under clinical suspicion of malignant melanoma in the umbilical region. She presented with a 4-month history of a painful and intermittently bleeding nodule on the umbilical area. The lesion was more prominent during her menstrual cycles and bled. She was otherwise in good general health and denied a history of abdominal or gynaecological surgery. There was no known medical history of endometriosis. On physical examination, she presented with approximately 1.5 cm soft, brown, well-circumscribed nodule on the inferior aspect of the umbilical area (figure 1). Based on her medical history and examination findings, umbilical endometriosis was suspected. A cutaneous biopsy was performed, which showed endometrial glands and stroma without atypia and scattered siderophages (figure 2). The patient was referred to the gynaecology team for further investigation. Ultrasound studies and abdominal/pelvic tomography did not show any evidence of concomitant pelvic endometriosis. She underwent local excision of the skin nodule with preservation of the umbilicus. No recurrences have been noticed after 1-year follow-up. Endometriosis is defined by the presence of functional endometrial tissue abnormally implanted outside the uterine cavity. Secondary cutaneous endometriosis may occur in surgical scars following hysterectomy, caesarean section, laparoscopy and episiotomy. However, primary (spontaneous) umbilical endometriosis is a rare entity defined by the presence of ectopic endometrial glands and stroma within the umbilicus without any history of pelvic endometriosis or surgery. It was initially described by Villar in 1886 and is also known as Villar’s nodule. It represents 0.5%–1% of all cases of extragenital endometriosis. The pathogenesis of cutaneous endometriosis is controversial. It may occur following iatrogenic haematological or lymphatic spreading of endometrial cells after abdominal or pelvic surgery in patients suffering from pelvic endometriosis. The aetiology of isolated umbilical endometriosis is not completely understood; metaplasia of urachus remnants has been proposed as a pathogenic mechanism. 2 It is important to remember that not all bleeding cutaneous lesions are malignant. The differential diagnosis of umbilical nodules is wide, mainly including haemangioma, umbilical hernia and urachus anomalies; less frequently, malignant diseases such as Sister Mary Joseph’s nodule, melanoma, sarcoma, adenocarcinoma and lymphoma should be considered. The risk of malignant transformation from umbilical endometriosis is low. Wide surgical excision is the treatment of choice, but medical hormonal therapy has also been successfully used to relieve the symptoms and to reduce the size of the endometrial nodule. Primary umbilical endometriosis should always be considered in the differential diagnoses of pigmented nodules on the umbilical region, especially if there is a history of cyclical bleeding, swelling and tenderness during menses. An umbilical bleeding nodule Hemal Shah, Salvador Diaz-Cano, Lucia Pozo-Garcia Images in...
منابع مشابه
Menstruating from the umbilicus as a rare case of primary umbilical endometriosis: a case report
INTRODUCTION Endometriosis is a common gynecological condition and presents mainly with involvement of the pelvic organs. Extrapelvic presentations in almost all parts of the body have been reported in the literature. However, umbilical endometriosis that is spontaneous or secondary to surgery is uncommon and accounts for only 0.5% to 1% of all endometriosis cases. CASE PRESENTATION A 35-year...
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Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. It affects 3 to 10 percent of women of reproductive age. Umbilical endometriosis is rare, with an estimated incidence of 0.5-1.0% among all cases of endometriosis, and is usually secondary to prior laparoscopic surgery involving the umbilicus. In this report, we described a case of umbilical endometrio...
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Umbilical endometriosis has an estimated incidence of 0.5%-1% of all patients with endometrial ectopia. It is a very rare disease, but should be considered on the differential diagnosis of umbilical lesions. We report on a case of spontaneous umbilical endometriosis in a 38-year-old woman, with a dark brown nodule periodically bleeding, associated with severe abdominal pain. There was no histor...
متن کاملBleeding umbilical nodule.
Received Accepted Med Ultrason 2011, Vol. 13, No 4, 331-332 Corresponding author: Corina Bocsa University Medical and Surgical Center Interservisan Cluj Napoca, România Email: [email protected] A 34 year old female patient was guided into the ultrasound office showing intermittent pain in the umbilical area and a small amount of bleeding from the umbilical scar, coinciding with the period of men...
متن کاملAn umbilical nodule with cyclical changes.
A 47 year old non-parous woman who had never had abdominal surgery was admitted with a four year history of an intermittently palpable nodule in the umbilical region. Initially, she noticed an increase in lesional size and pressure pain, which resolved within a few days. Six months before admission, blue-black discoloration appeared in the umbilical area; this vanishedwithin a week but reappear...
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عنوان ژورنال:
- BMJ case reports
دوره 2017 شماره
صفحات -
تاریخ انتشار 2017