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Detection of inguinal endometriosis by magnetic resonance imaging (MRI)
International Journal of Gynecology & Obstetrics 47 (1994) 297-298
Letter to the editor
Detection of inguinal endometriosis by magnetic resonance imaging (MRI) A. Imai*, K. Iida, T. Tamaya Department
of Obstetrics
and Gynecology.
Gifu
University
School of Medicine,
Tsukasamachi.
Gifu 500, Japan
Received 6 June 1994; revision received 5 July 1994; accepted I9 July 1994
Keywords:
Inguinal
endometriosis;
Magnetic
resonance imaging; Superficial
Endometrioses are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can also occur anywhere in the body. Unusual locations of endometrioses often pose difficult diagnostic and therapeutic problems. In particular, endometrioses in the groin can be treated with a false preoperative diagnosis of incarcerated hernia or lymphangitis [l-4]. This report documents a rare case of endometriosis arising in the right superficial inguinal ring. We report on the accuracy of magnetic resonance imaging (MRI) before surgical treatment in evaluating the lesion. A 39-year-old Japanese woman was referred to the Gifu University Medical Center because of a history of a bulge in her right groin of 1 year’s duration. The mass, painful during menses, increased in size and appeared to fluctuate in size in relation to her menstrual periods. She did not notice any change in size of the mass or pain on straining or coughing or on changing position. Her past medical history was unremarkable. * Corresponding author, Tel.: +81 582 651241; Fax: +81 582 659006.
inguinal ring
Fig. I. T2-weighted MR coronal image of the groin (SE 2000/30). A prominent tumor demonstrates higher signal intensity with clear separation from the surrounding soft tissue. Heterogenous signal intensity is seencentrally, suggestiveof organizing hemorrhage and fibrosis.
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDl 0020-7292(94)02200-l
298
A. Imai et al. /ht.
J. Gynecol. Obsret.
Her abdomen was not tender on examination. Physical examination revealed a bulge about the size of a walnut just outside the right superficial inguinal ring. This was cystic and non-reducible. Neither hernia nor palpable inguinal nodes were demonstrated. The counterpart groin was normal. Routine gynecologic examination was normal except for a right ovarian cyst, an ultrasonographic examination of which showed that the mass was most likely a dermoid cyst. The patient underwent MRI for evaluation of the inguinal mass. As shown in Fig. 1, MRI demonstrated a prominent irregular tumor (2 x 2 x 3 cm in size) surrounded by the ring of a lower signal. The central part had an inhomogeneous signal intensity, indicating organizing hemorrhage. Consideration of the ovarian cyst and the progressive tenderness in the inguinal mass led us to exploratory surgical management under the probable diagnosis of endometriosis in the right groin. On surgery, a firm and cystic structure was found in the right superficial inguinal ring. This structure seemed to be associated loosely with the distal extraperitoneal portion of the round ligament and was easily excised. In the pelvic cavity, there was 50 ml of straw-colored, clear ascites. The right adnexa was found to be replaced by a Scmsized unilocular cyst. The uterus and left adnexa were of normal appearance, and a right salpingooophorectomy was performed. The pelvic cavity was thoroughly examined and no evidence of endometriotic lesion was noted. Microscopic sections of the inguinal mass demonstrated typical features of endometriosis,
47 (1994) 297-298
and the removed ovarian specimen was a dermoid cyst, in which no endometriotic component was observed. It is difficult to evaluate the real incidence of inguinal endometriosis; it is probably more common than suspected. Many patients are treated by general surgeons with a false preoperative diagnosis of incarcerative hernia. To increase the diagnostic accuracy, more intensive uses of MRI are helpful. In fact, in our case, the lesion was resolved into areas of organizing hemorrhage and endometrial fibrotic walls and demarcated from the surrounding soft tissue. The lesion was well defined and had a prominent higher density. The margin and extension were accurately demarcated from the normal tissues. Considering the operative findings and the lesion size of the surgical specimen, the imaging was extremely accurate in assessing the location, size and extent of the lesion. This case might support MRI as a highly attractive diagnostic option for this disease in the groin. References 111 Clausen I, Nielsen KI. Endometriosis in the groin. Int J Gynecol Obstet 1987; 25: 469.
I21 Candiani GB, Vercellini P, Fedele L, Vendola N, Carinelli S, Scaglione V. Inguinal endometriosis: pathogenetic and clinical implications. Obstet Gynecol 1991; 78: 191. I31 Sataloff DM, La Vorgna KA, McFarland MM. Extrapelvic endometriosis presenting as a hernia: clinical reports and review of the literature. Surgery 1989; 105: 109. I41 Brzezinski A, Durst AL. Endometriosis presenting as an inguinal hernia. Am J Obstet Gynecol 1983; 146: 982.
Letter to the editor
Detection of inguinal endometriosis by magnetic resonance imaging (MRI) A. Imai*, K. Iida, T. Tamaya Department
of Obstetrics
and Gynecology.
Gifu
University
School of Medicine,
Tsukasamachi.
Gifu 500, Japan
Received 6 June 1994; revision received 5 July 1994; accepted I9 July 1994
Keywords:
Inguinal
endometriosis;
Magnetic
resonance imaging; Superficial
Endometrioses are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can also occur anywhere in the body. Unusual locations of endometrioses often pose difficult diagnostic and therapeutic problems. In particular, endometrioses in the groin can be treated with a false preoperative diagnosis of incarcerated hernia or lymphangitis [l-4]. This report documents a rare case of endometriosis arising in the right superficial inguinal ring. We report on the accuracy of magnetic resonance imaging (MRI) before surgical treatment in evaluating the lesion. A 39-year-old Japanese woman was referred to the Gifu University Medical Center because of a history of a bulge in her right groin of 1 year’s duration. The mass, painful during menses, increased in size and appeared to fluctuate in size in relation to her menstrual periods. She did not notice any change in size of the mass or pain on straining or coughing or on changing position. Her past medical history was unremarkable. * Corresponding author, Tel.: +81 582 651241; Fax: +81 582 659006.
inguinal ring
Fig. I. T2-weighted MR coronal image of the groin (SE 2000/30). A prominent tumor demonstrates higher signal intensity with clear separation from the surrounding soft tissue. Heterogenous signal intensity is seencentrally, suggestiveof organizing hemorrhage and fibrosis.
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDl 0020-7292(94)02200-l
298
A. Imai et al. /ht.
J. Gynecol. Obsret.
Her abdomen was not tender on examination. Physical examination revealed a bulge about the size of a walnut just outside the right superficial inguinal ring. This was cystic and non-reducible. Neither hernia nor palpable inguinal nodes were demonstrated. The counterpart groin was normal. Routine gynecologic examination was normal except for a right ovarian cyst, an ultrasonographic examination of which showed that the mass was most likely a dermoid cyst. The patient underwent MRI for evaluation of the inguinal mass. As shown in Fig. 1, MRI demonstrated a prominent irregular tumor (2 x 2 x 3 cm in size) surrounded by the ring of a lower signal. The central part had an inhomogeneous signal intensity, indicating organizing hemorrhage. Consideration of the ovarian cyst and the progressive tenderness in the inguinal mass led us to exploratory surgical management under the probable diagnosis of endometriosis in the right groin. On surgery, a firm and cystic structure was found in the right superficial inguinal ring. This structure seemed to be associated loosely with the distal extraperitoneal portion of the round ligament and was easily excised. In the pelvic cavity, there was 50 ml of straw-colored, clear ascites. The right adnexa was found to be replaced by a Scmsized unilocular cyst. The uterus and left adnexa were of normal appearance, and a right salpingooophorectomy was performed. The pelvic cavity was thoroughly examined and no evidence of endometriotic lesion was noted. Microscopic sections of the inguinal mass demonstrated typical features of endometriosis,
47 (1994) 297-298
and the removed ovarian specimen was a dermoid cyst, in which no endometriotic component was observed. It is difficult to evaluate the real incidence of inguinal endometriosis; it is probably more common than suspected. Many patients are treated by general surgeons with a false preoperative diagnosis of incarcerative hernia. To increase the diagnostic accuracy, more intensive uses of MRI are helpful. In fact, in our case, the lesion was resolved into areas of organizing hemorrhage and endometrial fibrotic walls and demarcated from the surrounding soft tissue. The lesion was well defined and had a prominent higher density. The margin and extension were accurately demarcated from the normal tissues. Considering the operative findings and the lesion size of the surgical specimen, the imaging was extremely accurate in assessing the location, size and extent of the lesion. This case might support MRI as a highly attractive diagnostic option for this disease in the groin. References 111 Clausen I, Nielsen KI. Endometriosis in the groin. Int J Gynecol Obstet 1987; 25: 469.
I21 Candiani GB, Vercellini P, Fedele L, Vendola N, Carinelli S, Scaglione V. Inguinal endometriosis: pathogenetic and clinical implications. Obstet Gynecol 1991; 78: 191. I31 Sataloff DM, La Vorgna KA, McFarland MM. Extrapelvic endometriosis presenting as a hernia: clinical reports and review of the literature. Surgery 1989; 105: 109. I41 Brzezinski A, Durst AL. Endometriosis presenting as an inguinal hernia. Am J Obstet Gynecol 1983; 146: 982.