Clinical management and immunohistochemical analysis of umbilical endometriosis.
OBJECTIVE
To established a strategy for diagnostic and therapeutic management of umbilical endometriosis and to determine the biological character.


METHODS
Clinical examination, vaginal and abdominal ultrasound, magnetic resonance imaging of the abdominal wall and laparoscopy were performed on a 42-year-old woman with umbilical endometriosis. Surgery with umbilical reconstruction was performed by a new plastic surgery technique. Immunohistochemical analyses (against Ki 67, estrogen/progestogen receptor, CD10, smooth muscle actin, desmin, caldesmon, von Willebrandt factor, cyclooxygensae-2 and VEGF) were done to characterize the umbilical endometriotic lesion.


RESULTS
The extension of the endometriotic lesion necessitated total removal of the umbilicus. Umbilical reconstruction was performed by a new plastic surgery technique. The lesion did express CD10, estrogen and progestogen receptors, and did show a moderate proliferation rate. Furthermore, signs of metaplastic processes such as smooth muscle metaplasia and angiogenesis were detected. The endometriotic lesion was positive not only for smooth muscle actin, caldesmon and desmin, but also for COX-2 and VEGF.


CONCLUSIONS
Based on a case report and a literature review, we discuss the diagnostic and therapeutic management of umbilical endometriosis at our endometriosis research center. Furthermore, our data suggest that the umbilical endometriotic lesion originated from reactivated multipotent cells.
Mechsner
Sylvia
S
Department of Gynecology, Endometriosis Research Center Charité, Charité, Campus Benjamin Franklin, Berlin, Germany. sylvia.mechsner@charite.de
Bartley
Julia
J
Infanger
Manfred
M
Loddenkemper
Christoph
C
Herbel
Johanna
J
Ebert
Andreas D
AD
D000328:Adult; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008875:Middle Aged; D014472:Umbilicus / Q000601:surgery*