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Review
. 2009 Sep;127(5):270-7.
doi: 10.1590/s1516-31802009000500005.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature

Guilherme Karam Corrêa Leite  1 , Luis Fernando Pina de Carvalho, Henri Korkes, Thiago Falbo Guazzelli, Grecy Kenj, Arildo de Toledo Viana
Affiliations
Review

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature

Guilherme Karam Corrêa Leite et al. Sao Paulo Med J. 2009 Sep.

Abstract
in English, Portuguese

Context and objective: The incidence of scar endometrioma ranges from 0.03 to 3.5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed.

Design and setting: Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva.

Methods: Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin.

Results: There were 33 patients, of mean age 30.1 +/- 5.0 years (range: 18-41 years). The total incidence was 0.11%: 0.29% in cesarean sections and 0.01% in vaginal deliveries. Twenty-nine tumors (87.9%) were located in cesarean scars, two (6.0%) in episiotomy scars and two (6.0%) in the umbilical region. The main symptom was localized cyclical pain (66.7%), of mean duration 30.5 months (+/- 23). Surgical treatment was successful in all cases.

Conclusion: This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.

CONTEXTO E OBJETIVO:: A incidência de endometrioma de cicatriz varia de 0,03 a 3,5%. Alguns fatores relacionados ao conhecimento da história clínica da doença dificultam o diagnóstico e o tratamento corretos. O objetivo é traçar o padrão clínico da doença e avaliar resultados cirúrgicos. Foi revisada a literatura sobre o assunto.

TIPO DE ESTUDO E LOCAL:: Estudo descritivo e retrospectivo realizado no Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva.

MÉTODOS:: Foi realizado levantamento e revisão de dados dos prontuários médicos das pacientes com diagnóstico pré-operatório de endometrioma de cicatriz, operadas entre 2001 e 2007. O diagnóstico pós-operatório foi feito por exame histopatológico. As principais informações levantadas foram: idade, antecedentes obstétricos, sintomatologia, localização, tamanho e palpação do tumor, duração da queixa, diagnóstico, tratamento. Todas as pacientes foram submetidas a exerese da massa tumoral com margem de segurança.

RESULTADOS:: Foram encontrados 33 pacientes com média de idade 30,1 (± 5,0), variando de 18 a 41 anos. A incidência total foi de 0,11%, nas cesarianas foi de 0,29% e nos partos vaginais, 0,01%. Localização do tumor: 29 casos em cicatriz de cesária (87,9%), dois em região umbilical (6,0%) e dois em cicatriz de episiotomia (6,0%). A principal sintomatologia foi dor cíclica localizada (66,7%), com duração média de 30,5 meses (± 23). O tratamento cirúrgico foi realizado com sucesso em todas as pacientes.

CONCLUSÃO:: Trata-se de uma doença incomum. O dado de maior importância diagnóstica foi: coincidência da sintomatologia dolorosa com a menstruação. Pacientes submetidas a cesariana têm maior risco (risco relativo = 27,37 e P < 0,01). O tratamento cirúrgico de escolha é exerese do endometrioma com margem de segurança.

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Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1.
Figure 1.. Endometrioma after resection. Note tumor formation consisting of whitish fibrous tissue and chocolate-like area on the surface.
Figure 2.
Figure 2.. Immunohistochemistry (hematoxylin-eosin x 100). Fibromuscular tissue (TF) with glandular structures marked out by lines of cubic cells (G), girdles for stromal endometrial cells with reduced cytoplasm (CE) and circumscribed hematic cells and debris (CH).
Figure 3.
Figure 3.. Diagnosing of scar endometrioma following cesarean section and vaginal delivery.
Figure 4.
Figure 4.. Ultrasound scan on a case of endometrioma in the abdominal wall (cesarean section scar). Details show hypoechoic image with posterior acoustic shadow.
Figure 5.
Figure 5.. Scar endometrioma in cesarean section scar: dissection and excision of supra-aponeurotic lesion.
See this image and copyright information in PMC

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