Dordević Momcilo, Jovanović Bozidar, Mitrović Slobodanka, Dordević Gordana, Radovanović Dragce, Sazdanović Predrag
University Department of Obstetrics and Gynecology, Kragujevac Clinical Center, Kragujevac.
Acta Clin Croat. 2009 Sep;48(4):439-43.
Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis is one of the most common gynecologic entities affecting 8%-18% of menstrual women. Endometriosis can occur at intra- and extrapelvic localizations. The most common intrapelvic localizations are those involving the ovaries, Douglas' area, pelvic peritoneum, uterus, bladder and rectum. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and usually develops in connective tissue. Extra-pelvic implantation of endometrial tissue may develop in any organ including the skin, lungs, liver, extremities, brain and stomach. Three years after cesarean section, a 35-year-old female was operated on for suspected anterior abdominal hernia at the site of previous section. An egg-sized tumor was removed from the rectus abdominis muscle and referred for histopathologic and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. A year after the procedure, treatment with gonadotropin-releasing hormone analogs was continued due to recurrent pain in the scar area, along with ultrasonography and biochemical marker (carbohydrate antigen 125) follow-up. Clinical diagnosis of scar endometriosis can be made by thorough history and physical, ultrasonography and biochemical examinations. Scar endometriosis should always be considered when the symptoms occur in a cyclic and hormone-dependent pattern, mostly after gynecologic operations, and worsening during menstruation. Definitive diagnosis is based on histopathologic analysis.
子宫内膜异位症是指在子宫外出现正常位于子宫内的功能性子宫内膜组织。子宫内膜异位症是最常见的妇科疾病之一，影响8%-18%的育龄女性。子宫内膜异位症可发生在盆腔内和盆腔外。盆腔内最常见的部位是卵巢、Douglas腔、盆腔腹膜、子宫、膀胱和直肠。腹部子宫内膜异位症是盆腔外子宫内膜异位症最常见的部位，通常发生在结缔组织中。子宫内膜组织的盆腔外种植可发生在任何器官，包括皮肤、肺、肝、四肢、脑和胃。剖宫产三年后，一名35岁女性因怀疑前次手术部位出现前腹壁疝而接受手术。从腹直肌中切除了一个鸡蛋大小的肿瘤，并送去进行组织病理学和免疫组织化学分析。结果显示肌肉存在子宫内膜异位症，雌激素和孕激素受体呈阳性。手术后一年，由于瘢痕区域反复疼痛，继续使用促性腺激素释放激素类似物治疗，并进行超声检查和生化标志物（糖类抗原125）随访。瘢痕子宫内膜异位症的临床诊断可通过详细的病史和体格检查、超声检查和生化检查做出。当症状呈周期性且依赖激素模式出现时，尤其是在妇科手术后出现，并在月经期间加重时，应始终考虑瘢痕子宫内膜异位症。确诊基于组织病理学分析。
