Michaella Cameron, David Howlett, Sarah Westwell and Ash Subramanian
East Sussex Healthcare Trust, UK
Posters & Accepted Abstracts: Surgery Curr Res
Cutaneous endometriosis is rare and represents less than 5.5% of known endometriosis cases. Endometrioma typically occurs in women of reproductive age. However, we describe a postmenopausal case of cutaneous endometriosis with an atypical presentation. A 66-year-old woman presented to the surgical assessment unit with a short history of a new palpable umbilical lesion. Nine months prior she had been diagnosed with invasive lobular breast carcinoma. Her treatment consisted of a mastectomy with axillary nodal clearance and radiotherapy. Her medical history included a hysterectomy and bilateral salpingo-oophorectomy for endometriosis (2000) and laparoscopic appendectomy (1986). She had been taking anastrozole following her breast cancer surgery. A computed tomography staging scan excluded metastatic spread. An ultrasound described a soft tissue umbilical mass, biopsy of the mass revealed endometrial type glands with surrounding endometrial type stroma which appeared non-functional. Subsequently, an approach of â??watchful waitingâ?? was adopted instead of surgical excision. Our patient did not present with typical symptoms of endometriosis, such as cyclical pain or bleeding. We hypothesize that the endometrial cells had implanted following her previous surgeries. However, this secondary form of cutaneous endometriosis presented markedly late and seemed to occur in the context of anastrozole (aromatase inhibitor). Clinical presentation of cutaneous umbilical endometriosis can mimic malignancies; especially in the context of recently diagnosed cancer. Histopathological examination is the gold standard and the diagnosis will exclude malignancy. Further clinical studies are needed to investigate the efficacy of aromatase inhibitors in the postmenopausal endometriosis before it can be considered a reliable treatment option.
Email: mxc900@doctors.org.uk
