Mazzeo Carmelo, Gammeri Emanuele, Foti Agata, Rossitto Maurizio, Cucinotta Eugenio
Ann Ital Chir. 2014 Dec 29;85(ePub):S2239253X14023482.
Endometriosis is not a well-known disease and sometimes its rare onset is a pathogenetic, diagnostic and therapeutic problem. The Canal of Nuck is an embryonal rest of the parietal peritoneum that accompanies the round ligament through the inguinal canal. The perviousness of the canal of Nuck could explain the pathogenesis of vulvar endometriosis.
We reported a case of vulvar endometriosis localization, which is rather uncommon, in a patient previously operated on with cyst of Nuck.
One of the most helpful instrumental exams in defining the nature of vulvar swallows is magnetic resonance, but it remains difficult to diagnose vulvar endometriosis in spite of the instrumental exam in our possession. The hypothesis of retrograde menstruation is supported by the fact that ovarian localization is the most common in this disease. Extra-pelvic localization as well as vulvar one are less common. The Canal of Nuck is an embryonal rest of the parietal peritoneum that accompanies the round ligament through the inguinal canal.
Endometriosis could be taken into consideration in differential diagnosis of vulvar swellings, and for this reason it is necessary to carry out a histological exam in every operated vulvar neoformation. We suggest vaginalis-peritonei duct contamination as a possible pathogenesis mechanism of this disease.
子宫内膜异位症并非广为人知的疾病，其罕见的发病情况有时会成为发病机制、诊断及治疗方面的难题。Nuck管是壁腹膜的胚胎残余组织，它伴随圆韧带穿过腹股沟管。Nuck管的通畅性可解释外阴子宫内膜异位症的发病机制。
我们报告了一例外阴子宫内膜异位症定位的病例，这种情况相当罕见，该患者此前曾接受过Nuck管囊肿手术。
在确定外阴肿物的性质时，最有用的辅助检查之一是磁共振成像，但尽管我们拥有相关辅助检查手段，外阴子宫内膜异位症的诊断仍然困难。逆行月经的假说得到了以下事实的支持：卵巢部位是该疾病最常见的发病部位。盆腔外定位以及外阴部位的发病则较少见。Nuck管是壁腹膜的胚胎残余组织，它伴随圆韧带穿过腹股沟管。
在对外阴肿物进行鉴别诊断时应考虑子宫内膜异位症，因此，对于每例接受手术的外阴新生物都有必要进行组织学检查。我们认为阴道-腹膜管污染是该疾病可能的发病机制。
