Tetsuya Hirata1, Kaori Koga2, Mari Kitade3, Shinya Fukuda2, Kazuaki Neriishi2, Fuminori Taniguchi4, Ritsuo Honda5, Naoko Takazawa6, Toshiaki Tanaka7, Masatoshi Kurihara8, Jun Nakajima9, Shigeo Horie6, Hidekatsu Nakai10, Takayuki Enomoto11, Masaki Mandai12, Hisashi Narahara13, Jo Kitawaki14, Tasuku Harada4, Hidetaka Katabuchi5, Kotaro Yoshimura15, Yutaka Osuga2. 1. Departments of Obstetrics and Gynecology (Drs. Hirata, Koga, Fukuda, Neriishi, and Osuga). Electronic address: thira-tky@umin.ac.jp. 2. Departments of Obstetrics and Gynecology (Drs. Hirata, Koga, Fukuda, Neriishi, and Osuga). 3. Departments of Obstetrics and Gynecology (Dr. Kitade). 4. Department of Obstetrics and Gynecology, Tottori University, Tottori (Drs. Taniguchi and Harada). 5. Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto (Drs. Honda and Katabuchi). 6. Urology (Drs. Takazawa and Horie), Juntendo University, Tokyo. 7. Surgical Oncology (Dr. Tanaka). 8. Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo (Dr. Kurihara). 9. Thoracic Surgery (Dr. Nakajima), University of Tokyo, Tokyo. 10. Department of Obstetrics and Gynecology, Kindai University, Higashiosaka (Dr. Nakai). 11. Department of Obstetrics and Gynecology, Niigata University, Niigata (Dr. Enomoto). 12. Department of Obstetrics and Gynecology, Kyoto University, Kyoto (Dr. Mandai). 13. Department of Obstetrics and Gynecology, Oita University, Oita (Dr. Narahara). 14. Department of Obstetrics and Gynecology, Kyoto Prefectural University, Kyoto (Dr. Kitawaki). 15. Department of Plastic Surgery, Jichi Medical University, Shimotsuke (Dr. Yoshimura), Japan.
Abstract
STUDY OBJECTIVE: To identify the clinical presentation, diagnostic evaluation, operative or medical management, and postoperative recurrence of umbilical endometriosis. DESIGN: A retrospective national survey. SETTING: Obstetrics and Gynecology and Plastic Surgery Departments at a teaching hospital in Japan. PATIENTS: Patients with umbilical endometriosis or malignant transformation. INTERVENTIONS: A national survey was conducted to identify and evaluate cases of umbilical endometriosis or malignant transformation documented between 2006 and 2016. MEASUREMENTS AND MAIN RESULTS: The following were evaluated for each patient: age at diagnosis, body mass index, medical history, presence of extragenital endometriosis, surgical history, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence, and time to recurrence. Ninety-six patients were identified with pathologically diagnosed benign umbilical endometriosis. The patients frequently had swelling (86.5%), pain (81.3%), or bleeding (44.8%) in the umbilicus. Sensitivity was 87.1% for physical examination, 76.5% for transabdominal ultrasonography, 75.6% for computed tomography, and 81.8% for magnetic resonance imaging. The cumulative recurrence rate was 1.34% at 6 months, 6.35% at 12 months, and 6.35% at 60 months after surgery. Importantly, there was no recurrence after wide resection including of the peritoneum (0 of 37 cases). The efficacy of dienogest (an oral progestin), gonadotropin-releasing hormone agonists, and oral contraceptives was 91.7%, 81.8%, and 57.1%, respectively. Finally, 2 cases of malignant transformation were identified. CONCLUSION: There was a low recurrence rate following surgery, and hormonal treatment is an option, although the current findings suggest surgical therapy as the first choice of treatment for umbilical endometriosis.
STUDY OBJECTIVE: To identify the clinical presentation, diagnostic evaluation, operative or medical management, and postoperative recurrence of umbilical endometriosis. DESIGN: A retrospective national survey. SETTING: Obstetrics and Gynecology and Plastic Surgery Departments at a teaching hospital in Japan. PATIENTS: Patients with umbilical endometriosis or malignant transformation. INTERVENTIONS: A national survey was conducted to identify and evaluate cases of umbilical endometriosis or malignant transformation documented between 2006 and 2016. MEASUREMENTS AND MAIN RESULTS: The following were evaluated for each patient: age at diagnosis, body mass index, medical history, presence of extragenital endometriosis, surgical history, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence, and time to recurrence. Ninety-six patients were identified with pathologically diagnosed benign umbilical endometriosis. The patients frequently had swelling (86.5%), pain (81.3%), or bleeding (44.8%) in the umbilicus. Sensitivity was 87.1% for physical examination, 76.5% for transabdominal ultrasonography, 75.6% for computed tomography, and 81.8% for magnetic resonance imaging. The cumulative recurrence rate was 1.34% at 6 months, 6.35% at 12 months, and 6.35% at 60 months after surgery. Importantly, there was no recurrence after wide resection including of the peritoneum (0 of 37 cases). The efficacy of dienogest (an oral progestin), gonadotropin-releasing hormone agonists, and oral contraceptives was 91.7%, 81.8%, and 57.1%, respectively. Finally, 2 cases of malignant transformation were identified. CONCLUSION: There was a low recurrence rate following surgery, and hormonal treatment is an option, although the current findings suggest surgical therapy as the first choice of treatment for umbilical endometriosis.