Clinicopathological features of endometriosis in abdominal wall - Clinical analysis of 151 cases

Abstract

Objective: To explore the clinicopathological features of abdominal wall endometriosis (AWE). Materials and Methods: A retrospective study was made of 151 AWE patients, who were treated at Obstetrics and Gynecology Hospital, Fudan University from 2003 to 2010. Results: Most patients (80.1%) presented with cyclic pain and/or cyclic abdominal masses. The latent period of AWE patients was 31.48 ± 28.27 months (three to 192 months), which was not correlated with factors related to previous cesarean section (CS) (such as age at CS, incision site, gestational week at CS, baby's birth weight, lactation period, postpartum menstruation recovery, choices of contraceptives, etc). The duration of disease was 33.07 ± 28.58 months (two to l68 months), which was negatively correlated with the latent period (r = -0.267, p=0.043). The pre-operational ultrasonography detection rate was 97.4% (147/151 cases). The lesion size detected by preoperative ultrasonography was significantly smaller than that measured intraoperatively by palpation (21.6 ± 20.7mm vs. 30.21 ± 30.9mm p> 0.05). Moreover, only 26.5% (40/151 cases), in AWE patients the infiltration depth was revealed by preoperative ultrasonography. All patients received surgical treatment. The symptoms were relieved in 93.4% (141/151 cases) patients after surgery. The recurrence rate was 7.3% (11/151 cases) while the average recurrent time was 19.8 ± 15.99 months. The recurrence rate was significantly lower in postoperative medication group than that in non-medication one (p < 0.05). In addition, the morphologic features of AWE lesions also contributed to recurrence. The duration of disease in large scar endometrioma (LSE) group (the diameter of lesions ≥ three cm) was significantly longer than that in small scar endometrioma (SSE) group (the diameter of lesions < three cm), while SSE group had higher recurrence rate (p < 0.05). Conclusions: The indications of previous CS, factors related to delivery and lactation, have little effect on the exact time of AWE onset. Although ultrasonography is beneficial to preoperative diagnosis of AWE, its accuracy in evaluating lesion size and infiltration depth is limited, which should be interpreted appropriately. The morphologic features of AWE lesions may be correlated with the severity of disease. Surgery is the first-line treatment of AWE and postoperative medication might reduce recurrence.