Cytomorphological spectrum in scar endometriosis: a study of eight cases.
OBJECTIVE
Endometriosis due to ectopic endometrial tissue that responds to hormonal stimulation and is extremely rare in a surgical scar appearing in 0.1% of women who have undergone Caesarean section. Fine needle aspiration cytology (FNAC) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses.


METHODS
We present the cytomorphological spectrum in eight cases of abdominal wall endometriosis diagnosed by FNAC over a 6-year period (June 1998-June 2004) in Mubarak Al-Kabeer Hospital (Kuwait). The patients ranged from 27 to 56 years of age. Seven had a prior Caesarean section and one had a hysterectomy for fibroid. They presented 3-8 years later with nodules in/near the abdominal scar. Five cases presented with a painful nodule, fluctuant with the menstrual cycle.


RESULTS
Cytological findings comprised epithelial clusters and fusiform stromal cells with numerous haemosiderin-laden macrophages. Mild to moderate epithelial atypia was observed in three cases. A diagnosis of endometriosis was rendered in all the eight cases and tissue was available in four cases.


CONCLUSIONS
Endometriotic nodules need to be differentiated from other benign/malignant masses and evaluated for possible malignant transformation. FNAC provides a safe and effective tool for diagnosis thereby obviating the need for other procedures.
Pathan
S K
SK
Mubarak Al-Kabeer Hospital, Kuwait University, Kuwait.
Kapila
K
K
Haji
B E
BE
Mallik
M K
MK
Al-Ansary
T A
TA
George
S S
SS
Das
D K
DK
Francis
I M
IM
D000005:Abdomen; D000328:Adult; D044963:Biopsy, Fine-Needle; D002585:Cesarean Section; D002921:Cicatrix / Q000473:pathology*; D004715:Endometriosis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008264:Macrophages / Q000473:pathology; D008875:Middle Aged; D017154:Stromal Cells / Q000473:pathology