Cutaneous Tattoo Ink as a Mimicker of Endometriosis-Like Lesions on Diagnostic Laparoscopy

Abstract

This paper presents the case of a 28-year-old with a history of chronic pelvic pain suspicious of endometriosis. She underwent a diagnostic laparoscopy and biopsy of lesions along the posterior cul-de-sac and right sidewall near the external iliac artery. Histopathological examination revealed no evidence of endometriosis but did comment on benign lymph node tissue with tattoo-like pigment. These findings correspond to the patient's tattoos located along the lower extremities. It is suspected there was cutaneous tattoo ink migration causing intra-abdominal lymphadenopathy, which visually mimicked endometriosis on diagnostic laparoscopy. Surgeons should become familiar with and recognize this phenomenon, as it can be misleading in the setting of endometriosis and diagnostic laparoscopy. Surgeons undertaking these cases must be able to identify and safely excise abnormal-appearing lesions in many different locations to prevent a missed or delayed diagnosis of endometriosis.

Keywords: chronic pelvic pain; diagnostic laparoscopy; endometriosis; tattoo ink; women’s health.

Figure 1. A dark lesion (arrow) resembling gunpowder along the right sidewall

Figure 2. Pigment (arrow) is predominantly intracellular and present in the cytoplasm of histiocytes (20X)

Figure 3. Anterolateral view of the right lower extremity displaying multiple patient tattoos