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Review
. 2020 Feb 10;17(4):536-542.
doi: 10.7150/ijms.38679. eCollection 2020.

Abdominal wall endometriosis (a narrative review)

Mara Carsote  1 , Dana Cristiana Terzea  2 , Ana Valea  3 , Ancuta-Augustina Gheorghisan-Galateanu  4
Affiliations
Review

Abdominal wall endometriosis (a narrative review)

Mara Carsote et al. Int J Med Sci. .

Abstract

One of the rarest forms of endometriosis is abdominal wall endometriosis (AWE), which includes caesarean scar endometriosis. AWE remains a challenging condition because some issues related to this topic are still under debate. The increasing number of caesarean sections and laparotomies will expect to increase the rate of AWE. The current incidence in obstetrical and gynaecological procedures is still unknown. The disease is probably underestimated. The pathogenic mechanism involves local environment at the implant site including local inflammation and metalloproteinases activation due to local growth factors, estrogen stimulation through estrogen receptors and potential epigenetic changes. However, the underlying mechanisms are not fully explained, and we need more experimental models to understand them. The clinical presentation is heterogeneous; the patient may be seen by a gynaecologist, an endocrinologist, a general surgeon, an imaging specialist, or even an oncologist. No particular constellation of clinical risk factors has been identified, and the histological report is the major diagnostic tool for confirmation. Surgery is the first line of therapy. Further on we need protocols for multidisciplinary investigations and approaches.

Keywords: abdominal wall endometriosis; caesarean scar endometriosis; endometriosis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Abdominal wall endometriosis. Immunohistochemistry report. A. High oestrogen receptor positivity in the epithelium of the endometrial glands (arrow heads) and in stroma (arrow). Cell nuclei are stained intensely for estrogen receptors (10x). B. CD10 positivity in the endometrial stroma (arrow) (10x).
Figure 2
Figure 2
A case of a 44-year-old female diagnosed with abdominal wall endometriosis 14 years after a caesarean section. She had chronic pain unrelated to the menstrual cycle. A. Preoperative aspect: computed tomography showing a poorly defined tumour of 3.9 cm at the abdominal wall, with a heterogeneous aspect. B. Post-operative aspect by computed tomography.
Figure 3
Figure 3
A. Abdominal wall endometriosis. Endometrial glands (arrow heads) and stroma (arrows) in the abdominal wall; HE stain, 4x (A), 10x (B).
See this image and copyright information in PMC

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