Department of Dermatology, New York University
PATIENT: 29-year-old woman
DURATION: Three months
HISTORY: The patient presented with a three-month history of a slowly growing, mildly painful nodule in the umbilicus. There was no history of bleeding or cyclic fluctuation in size. Her past medical history and surgical history were unremarkable.
PHYSICAL EXAMINATION: There was an 8-x-6-mm, soft, dome-shaped, brown nodule in the umbilicus.
LABORATORY DATA: None
HISTOPATHOLOGY: There is a dome-shaped lesion that is characterized by glandular structures which are lined by endometrial epithelial cells and are surrounded by a cellular stroma with extravasated erythrocytes.
COMMENT: Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Extrapelvic endometriosis may occur in up to 12 percent of women with endometriosis. Umbilical endometriosis is rare with an estimated incidence of 0.5 to 1.0 percent of all patients with endometrial ectopia. More commonly, cutaneous endometriosis occurs in a surgical scar from abdominal or pelvic procedures, which include hysterectomy, cesarean sections, episiotomy, and laparoscopy.[3,4] The lesion is often slightly tender and painful. At the time of menstruation, the pain becomes more pronounced and may be associated with swelling and slight bleeding of the lesion.
The etiology of cutaneous endometriosis that develops in surgical scars is probably implantation of viable endometrial cells. In contrast, cases of spontaneous cutaneous endometriosis may arise from endometrial tissue that is transported via lymphatics or vascular channels.
Simple surgical excision of the umbilical endometrioma, with sparing of the umbilicus when possible, is the treatment of choice. Local recurrence after adequate surgical excision is uncommon. Rare cases have undergone malignant transformation and give rise to endometrial carcinoma. The possibility of coexisting genital-pelvic endometriosis should be investigated. Hormonal therapy may be a consideration when there is coexistent pelvic endometriosis.
References1. Franklin RR, Navarro C. Extragenital endometriosis. In: Chadha DR, Buttran VC, eds. Current Concepts in Endometriosis. New York: Alan R. Liss, Inc. 1990, p. 289
2. Michowitz M; Baratz M; Stavorovsky M. Endometriosis of the umbilicus. Dermatologica, 1983, 167(6):326-30 PubMed.
3. Steck WD, et al. Cutaneous endometriosis. JAMA 1965;191:167.
4. Albrecht LE; Tron V; Rivers JK. Cutaneous endometriosis. International Journal of Dermatology, 1995 Apr, 34(4):261-2 PubMed.
5. Purvis RS, et al. Cutaneous and subcutaneous endometriosis surgical and hormonal therapy. Journal of Dermatologic Surgery and Oncology, 1994 Oct, 20(10):693-5 PubMed.
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