Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue - Ansin 235, Boston, USA.
Department of Surgical Pathology, Beth Israel Deaconess Medical Center, Boston, USA.
Abdom Radiol (NY). 2020 Jun;45(6):1800-1812. doi: 10.1007/s00261-018-1666-1.
To review the clinical, multimodality imaging, and pathologic characteristics of abdominal wall endometriosis (AWE), the most common type of extra-pelvic endometriosis.
116 women with histopathologically confirmed extragenital endometriosis diagnosed between 2/2014 and 6/2017 were evaluated retrospectively. Of these, 26 (22.4%) were found to have AWE and 18/26 met inclusion criteria for imaging. Available imaging studies were re-reviewed by two expert radiologists. Data regarding clinical features, histopathologic findings, and management were collected through medical record review.
21 pathology-proven AWE deposits were identified by imaging in 18 women [mean age at diagnosis of 38.5 years (range 31-48)]. Prior C-section was present in 15/18 (83.3%) and pelvic endometriosis in 3/18 (16.7%) patients. Patients presented with abdominal pain in 14/18 (77.8%) cases, which was cyclical in 8/14; palpable mass in 12/18 (66.7%); fluid discharge in 2/18 (11.1%); and local skin discoloration in 2/18 (11.1%). Of the 21 lesions, 15 were evaluated with US, 10 with CT, and 5 with MRI. Mean lesion dimensions were 2.5 × 2.2 × 2.6 cm, and deposits were predominantly located at midline or left hemiabdomen [22/30 (73.3%)], were either stellate [15/30 (50%)] or round [15/30 (50%)] in shape, had ill-defined margins [21/30 (70%)], were heterogenous in appearance [27/30 (90%)], and involved both deep and superficial abdominal wall layers [17/30 (56.7%)]. On US, lesions were mainly isoechoic/hyperechoic [7/15 (46.7%)], and scarcely vascular [8/15 (53.3%)] with a peripheral vascular pattern [8/13 (61.5%)]. On CT, AWEs were hypervascular and homogeneous [8/10 (80%)], superiorly located to scar tissue, and on MRI lesions appeared hyperintense [4/5 (80%)] to muscle with T2 cystic and T1 hemorrhagic foci [4/5 (80%)]. In 23/27 (85.1%) original reports, there was at least one known mass prior to imaging; AWE was correctly diagnosed in only 7/23 (30.4%) cases. In those with no prior knowledge of a mass, the lesion was detected in 3/4 (75%), but AWE was only diagnosed in a single case. Median time between onset of symptoms and histopathology was 24.41 moths (IQR 15.18-47.33).
AWE is a challenging clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. Familiarity with its radiologic features holds the potential for positively impacting diagnosis.
回顾腹壁子宫内膜异位症（AWE）的临床、多模态影像学和病理特征，AWE 是最常见的盆腔外子宫内膜异位症类型。
回顾性分析 2014 年 2 月至 2017 年 6 月期间经组织病理学证实的 116 例妇科外子宫内膜异位症患者的临床资料。其中 26 例（22.4%）为 AWE，26 例中 18 例符合影像学纳入标准。两名专家级放射科医生对现有影像学研究进行重新评估。通过病历回顾收集临床特征、组织病理学发现和治疗相关数据。
18 例女性患者的影像学检查共发现 21 个病理证实的 AWE 病灶（诊断时的平均年龄为 38.5 岁[范围 31-48]）。15/18（83.3%）例患者有剖宫产史，3/18（16.7%）例患者有盆腔子宫内膜异位症。14/18（77.8%）例患者出现腹痛，其中 8/14 例为周期性腹痛；12/18（66.7%）例患者可触及包块；2/18（11.1%）例患者有液体渗出；2/18（11.1%）例患者有局部皮肤变色。21 个病灶中，15 个病灶行超声检查，10 个病灶行 CT 检查，5 个病灶行 MRI 检查。病灶的平均大小为 2.5×2.2×2.6cm，主要位于中线或左侧半腹部[22/30（73.3%）]，形态呈星状[15/30（50%）]或圆形[15/30（50%）]，边界不清[21/30（70%）]，呈混杂信号[27/30（90%）]，累及深层和浅层腹壁[17/30（56.7%）]。超声检查显示病灶主要为等回声/高回声[7/15（46.7%）]，且几乎无血流信号[8/15（53.3%）]，呈周边血流模式[8/13（61.5%）]。CT 检查显示 AWE 呈高血管性且均匀强化[8/10（80%）]，位于瘢痕组织上方，MRI 检查显示病灶呈高信号[4/5（80%）]，T2 呈囊性，T1 呈出血性灶[4/5（80%）]。在 27 份原始报告中的 23 份（85.1%）中，在影像学检查前至少有一个已知的肿块；23 例中有 7 例（30.4%）正确诊断为 AWE。在那些没有肿块病史的患者中，有 3/4（75%）例患者发现了病灶，但仅在 1 例中诊断为 AWE。症状发作和组织病理学之间的中位时间为 24.41 个月（IQR 15.18-47.33）。
尽管有多种影像学方法，但 AWE 是一种具有挑战性的临床实体，其诊断常常存在明显延迟，且容易误诊。熟悉其影像学特征有可能对诊断产生积极影响。
