Endometriosis With Regenerative Skeletal Muscle Cells In The Abdominal Wall After Cesarean Section: A Case Report

Prilly Astari; Ricky Susanto; Ong Tjandra; Fresia Juwitasari Wongkar

Authors

Prilly Astari Department of Obstetrics and Gynecology, Bethsaida Hospital, Tangerang
Ricky Susanto Department of Obstetrics and Gynecology, Bethsaida Hospital, Tangerang
Ong Tjandra Department of Obstetrics and Gynecology, Bethsaida Hospital, Tangerang
Fresia Juwitasari Wongkar Department of Anatomical Pathology, Bethsaida Hospital, Tangerang

Keywords:

Endometriosis of musculoskeletal tissue, Wide excision, Cesarean section scar, Striated muscle cell regeneration

Abstract

Endometriosis in the abdominal wall following a caesarean section is an uncommon occurrence, accounting for only 0.03%- 1.5%. Diagnosis is often late, so symptoms become more severe or the mass size increases. Delayed diagnosis increases morbidity, complications, and the complexity of treatment to reduce symptoms and remove the endometriosis mass. We report a 33-year-old female patient with a mass in the anterior abdominal wall that appeared over the past two months. The patient experienced mass enlargement and cyclic pain which began three days before menstruation. The patient had a history of one cesarean section and did not use contraception. Ultrasonography examination showed a mixechoic image of the anterior abdominal wall of the cesarean section scar measuring 2.48 x 2.45 x 1.38 cm. We performed a wide excision up to 1 cm outside the mass. Pathological anatomy showed endometrial glands and stroma between skeletal muscle tissue that were consistent with external endometriosis with regenerative skeletal muscle cells. Understanding the histology and immunohistochemistry of muscle cell regeneration, as well as basic clinical examination, is very helpful in establishing a diagnosis so that appropriate management can be carried out.

References

M. P. Andres, F. V. L. Arcoverde, C. C. C. Souza, L. F. C. Fernandes, M. S. Abrão, and R. M. Kho, “Extra-Pelvic Endometriosis: A Systematic Review,” J. Minim. Invasive Gynecol., vol. S1553-4650, no. 19, pp. 31256–7, 2019, doi: 10.1016/j.jmig.2019.10.004.

Y. Moradi et al., “A systematic review on the prevalence of endometriosis in women,” Indian J. Med. Res., vol. 154, no. 3, p. 446, 2021, doi: 10.4103/ijmr.IJMR_817_18.

C. Meuleman et al., “Surgical treatment of deeply infiltrating endometriosis with colorectal involvement,” Hum. Reprod. Update, vol. 17, no. 3, pp. 311–326, May 2011, doi: 10.1093/humupd/dmq057.

R. Mirza, J. Abdulsattar, and J. Cotelingam, “Endometriosis Associated Striated Muscle Changes: Simulating Tumor,” Case Rep. Pathol., vol. 2021, pp. 1–4, Feb. 2021, doi: 10.1155/2021/6666283.

B. R. Mason, D. Chatterjee, C. O. Menias, P. H. Thaker, C. L. Siegel, and M. Yano, “Encyclopedia of endometriosis: a pictorial rad-path review,” Abdom. Radiol., vol. 45, no. 6, pp. 1587–1607, Jun. 2020, doi: 10.1007/s00261-019-02381-w.

E. Saffarieh and S. R. Y. Sharami, “A review on the management of endometriosis induced pain endometriosis,” Pakistan J. Med. Heal. Sci., vol. 13, no. 4, pp. 1057–1064, 2019.

M. Arafah, S. Rashid, and M. Akhtar, “Endometriosis: A Comprehensive Review,” Adv. Anat. Pathol., vol. 28, no. 1, pp. 30–43, Jan. 2021, doi: 10.1097/PAP.0000000000000288.

A. Musarò, “The Basis of Muscle Regeneration,” Adv. Biol., vol. 2014, pp. 1–16, Jul. 2014, doi: 10.1155/2014/612471.

R. Colella, M. G. Mameli, G. Bellezza, R. Del Sordo, A. Cavaliere, and A. Sidoni, “Endometriosis-associated Skeletal Muscle Regeneration: A Hitherto Undescribed Entity and a Potential Diagnostic Pitfall,” Am. J. Surg. Pathol., vol. 34, no. 1, pp. 10–17, Jan. 2010, doi: 10.1097/PAS.0b013e3181c12491.

M. Massimiani, V. Lacconi, F. La Civita, C. Ticconi, R. Rago, and L. Campagnolo, “Molecular Signaling Regulating Endometrium–Blastocyst Crosstalk,” Int. J. Mol. Sci., vol. 21, no. 1, p. 23, Dec. 2019, doi: 10.3390/ijms21010023.

P. Vercellini, P. Viganò, E. Somigliana, and L. Fedele, “Endometriosis: pathogenesis and treatment,” Nat. Rev. Endocrinol., vol. 10, no. 5, pp. 261–275, May 2014, doi: 10.1038/nrendo.2013.255.

H. S. Taylor, A. M. Kotlyar, and V. A. Flores, “Endometriosis is a chronic systemic disease: clinical challenges and novel innovations,” Lancet, vol. 397, no. 10276, pp. 839–852, Feb. 2021, doi: 10.1016/S0140-6736(21)00389-5.

X. Gao, Y.-C. Yeh, J. Outley, J. Simon, M. Botteman, and J. Spalding, “Health-related quality of life burden of women with endometriosis: a literature review,” Curr. Med. Res. Opin., vol. 22, no. 9, pp. 1787–1797, Sep. 2006, doi: 10.1185/030079906X121084.

H. Ye, C. Shen, Q. Quan, M. Xi, and L. Li, “Endometriosis of the skeletal muscular system (ESMS): a systematic review,” BMC Womens. Health, vol. 23, no. 1, p. 37, Jan. 2023, doi: 10.1186/s12905-023-02184-8.

N. Magon, “Gonadotropin releasing hormone agonists: Expanding vistas,” Indian J. Endocrinol. Metab., vol. 15, no. 4, p. 261, 2011, doi: 10.4103/2230-8210.85575.

N. Berlanda, E. Somigliana, M. P. Frattaruolo, L. Buggio, D. Dridi, and P. Vercellini, “Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician?,” Eur. J. Obstet. Gynecol. Reprod. Biol., vol. 209, pp. 67–71, Feb. 2017, doi: 10.1016/j.ejogrb.2016.07.513.