Mass in the Navel Turning out to be Umbilical Endometriosis

by Reynaldo O Josonon Friday, April 27, 2012 at 10:22pm ·

Mass in the Navel Turning out to be Umbilical Endometriosis

Reynaldo O. Joson,MD, MHA, MHPEd, MSc Surg

April 28, 2012

A mass that is palpated in the umbilicus or navel can be cancerous or not cancerous.

In this particular patient of mine, the umbilical mass turns out an umbilical endometriosis.

My patient was a 40 plus-year-old female who presented with the umbilical mass with a history of enlarging and becoming very painful during her mense and size of the mass becoming smaller and pain subsiding after mense.

With this history, I suspected umbilical endometriosis despite a pelvic ultrasound showing no abnormality in her uterus.

I did an excision under local anesthesia and outpatient.  The histopathological report showed umbilical endometriosis.

Thus, a mass in the navel or umbilicus should be suspected to be an umbilical endometriosis if there is history of changes in size and pain during menstruation.

Endometriosis is a condition in which bits of the tissue similar to the lining of the uterus (endometrium) grow in other parts of the body. Like the uterine lining, this tissue builds up and sheds in response to monthly hormonal cycles. However, there is no natural outlet for the blood discarded from these implants. Instead, it falls onto surrounding organs, causing swelling and inflammation. This repeated irritation leads to the development of scar tissue and adhesions in the area of the endometrial implants. (http://medical-dictionary.thefreedictionary.com/endometriosis+externa)

There are two general types of endometriosis, interna and externa.

In interna, the endometriosis is located in the main internal genital organs, most common sites are the ovaries and uterus itself, specifically in the myometrium, the muscle layer in the uterus just adjacent to the endometrium which is the mucous membrane lining the inside of the uterus.

In externa, the endometriosis is located outside the uterus, such as in the perineum, umbilicus, and intestines.

I have seen and operated on endometriosis externa in the umbilicus, about 2 cases, and in the rectum, about 2 cases also, during the past 30 years.

In the literature, endometriosis externa has been reported not to be very common.  Endometriosis interna is more common than endometriosis externa.

Below are the pictures of the most recent experience with umbilical endometriosis.

Enlarging and painful during menstruation

Decreasing in size after menstruation

Picture before operation

The umbilical mass after being excised

Note the areas of bleeding within the mass (mense in the mass)

 

The wound closed right after excision of the umbilical mass

 

 

Reynaldo O. Joson, MD

Surgical Oncologist

ROJoson Tumor and Cancer Clinic

Manila Doctors Hospital