Clinical specialists who are not accustomed to seeing patients with endometriosis may overlook the signs of gynaecological procedure scars in their patients. Scars that result from procedures such as diagnostic amniocentesis during pregnancy or from non-gynaecological surgeries such as appendectomies or umbilical hernioplasties may cause endometriosis nodes. Since it is important to recognize the techniques to diagnose gynaecological scars in patients with endometriosis, a group from the Endometriosis Unit at Universitary Hospital in Spain collected data on patients with gynaecological scars and noted the techniques used for diagnosis.
A total of 17 patients in 12 years were identified at the researchers’ hospital, underscoring the rarity of endometriosis nodes in gynaecological scars. The researchers collected data concerning the age of the patient at the time of diagnosis, the time that had passed between the culprit surgery and the diagnosis, patients’ symptoms, location of the scars, and how the patients were diagnosed and treated. These data were reported in “Endometriosis Node in Gynaecologic Scars: A Study of 17 Patients and the Diagnostic Considerations in Clinical Experience in Tertiary Care Center” and published in BMC Womens Health.
On average, women in the study were in their reproductive age (approximately 32.5 years old) and received their diagnosis of endometriosis nodes 4.2 years after surgery. Most patients reported painful masses that grew during menstruation. Their clinicians usually used computed tomography (CT), magnetic resonance imaging (MRI), or fine needle aspiration to make a diagnosis. Afterwards, patients were treated with surgical removal of the node and surrounding tissue as a margin of safety.
In the study, the team also debated the cause of endometriosis. “The theory of direct implantation is widely accepted by many authors,” wrote the researchers. “Other theories argue that an endometriosic node in scars occurs because of scar tissue metaplasia, and other hypothesis defends migration through lymphatic or vascular vessels to distant sites.” No matter the reason for endometriosis, knowing that CR, MRI, and ultrasound can help identify endometriosis nodes, clinicians can use these techniques to determine if a pathology examination is required to properly diagnose and treat their patients.
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