**11. References**


from 33 (over 24%) operated patients during on an average 19 months. It might be caused by larger size of endometriomas and no medical therapy after their excision. Leite et al. (38)

Sampson (49) was the first to document the possibility of malignant changes in ectopic endometrial tissue. Chene et al. (12) consider that 0,3 – 1% of scar endometriosis undergo malignant degeneration reporting a case of serous papillary cystadenocarcinoma. In our clinical material (43) also in one patient after two surgical removals of the cesarean scar endometriosis preformed in other centers (where endometrioma was diagnosed) papillary adenocarcinoma was recognized. Matsuo et al. (39) described primary clear cell carcinoma developed in previous abdominal scar post endometriosis surgery. Authors mentioned that endometrioid adenocarcinoma, clear cell adenocarcinoma and adenosarcoma are also common enough in extragenital localization. Razzouk et al. (46) reported a case of mixed clear cell and endometrioid carcinoma arising in a recurrent cesarean section scar

All the menstruating women or postmenopausal, especially using hormone replacement therapy, in whose cases any lesion in any postoperative scar or nearby them appear, should be suspected of endometriosis. It should be kept in mind that lesions of an abdominal wall or another regions of the body even without operation in past might be of endometriotic origin. In unclear cases additional proper diagnostic examinations are advised

The wide excision of the lesion with possible fascial or muscular repair should be offered in these cases and histopatological examination ought to be performed by an experienced histopathologist because of a possibility of malignancy. One should remember that

Medical treatment being less invasive than the surgical one, may be developed and seems to

Unnecessary operations, especially cesarean sections, should be avoided and if performed,

[2] Akagi T., Yamamoto S., Kobayashi Y., Fujita S., Akadu T., Moria Y. & Kato T.: *A case of* 

[3] Alpay Z., Saed G.M. & Diamond M.P.: *Female infertility and free radicals: potential role in* 

*endometriosis of the appendix with adhesion to right ovarian cyst presenting as intususpection of a mucocele of the appendix.* Surg Laparosc Endosc Percutan Tech

diagnostic pitfalls, particularly among general surgeons often occur.

one should be aware of the transmission of endometrial cells in the wound.

Further systematic investigations in the field of scar endometriosis are still needed.

[1] Agarwal A. & Fong Y.F.: *Cutaneous endometriosis.* Singapore Med J 2008, 49, 704-9.

*adhesions and endometriosis.* J Soc Gynecol Investig 2006, 13, 390-8.

described only two cases (6,0%).

endometrioma.

preoperatively.

**10. Closing remarks** 

be promising in the future.

2008, 18, 622-5.

**11. References** 


Endometrial Tumors in Postoperative Scars - Pathogenesis, Diagnostics and Treatment 99

[40] Neumann G., Rasmussen K.L. & Petersen L.K.: *Cervical adenosquamous carcinoma. Tumor* 

[41] Nominato N.S., Prates L.F.V.S., Lauar I., Morais J., Maia L. & Geber S.: *Caesarean section* 

[42] Odobasić A., Pasić A,. Iljazović-Latifagić E., Arnautalić L., Odobasić Ad., Idrizović E.,

[43] Olejek A., Zamłyński J., Podwińska E., Horák S., Paliga-Żytniewska M. & Kellas-Ślęczka

[44] de Oliveira M.A., de Leon A.C., Freire E.C., de Oliveira H.C. & Study S.O.: *Risk factors* 

[45] Oner G., Oczelik B., Ozgun M.T., Serin I.S., Ozturk F. & Basbug M.: *The effects of* 

[46] Razzouk K., Roman H., Chanavaz-Lacheray I., Scotté M., Verspyck E. & Marpeau L.:

[47] Rier S.E., Martin D.C., Bowman R.E., Dmowski W.P. & Becker J.L.: *Endometriosis in* 

[48] Rosina P., Pugliarello S., Colato C. & Girolomoni G.: *Endometriosis of umbilical cicatrix: Case report and review of the literature.* Acta Dermatovenerol Croat 2008, 16, 218-21. [49] Sampson J.A.: *Endometrial carcinoma of the ovary arising in endometrial tissue in that organ.* 

[50] Sampson J.A.: *The development of the implantation theory for the origin of peritoneal* 

[51] Schrodt G.R., Alcorn M.O. & Ibanez J.: *Endometriosis in the male urinary system: a case* 

[52] Singh M., Sivanesan K., Ghani R. & Granger K.: *Caesarean scar endometriosis.* Arch

[53] Skrzypczak J.: *Farmakologiczne leczenie endometriozy.* In: *Endometrioza.* (red. Wielgoś M.),

[54] Szymanowski K., Chmaj-Wierzchowska K., Yatczenko A., Niepsuj-Biniaś J., Florek E.,

[55] Teng C.C., Yang H.M., Chen K.F., Yang C.J., Chen L.S. & Kuo C.L.: *Abdominal wall* 

[56] Wicherek Ł., Dutsch-Wicherek M., Gałązka K., Banaś T., Popiela T., Lazar A. &

Opala T. & Murawski M.: *Endometriosis prophylaxis and treatment with the newly developed xenogenic immunomodulator RESAN in an animal model.* Eur J Obstet

*endometriosis: an overlooked but possibly preventable complication.* Taiwan J Obstet

Kleinrok-Podsiadło B.: *Comparison of RCAS 1 and metallothionein expression and the* 

*greatly increases risk of scar endometriosis.* Eur J Obstet Gynecol Reprod Biol 2010, 152,

Dervisefendić M. & Dedić L.: *Perineal endometriosis: A case report and review of the* 

S.: *Guzy endometrialne w bliznach po cięciu cesarskim. [Abdominal Wall endometrioma in* 

*for abdominal scar endometriosis atfer obstetrics hysterotomies: a case control study*. Acta

*metformin and letrozole on endometriosis and comparison of the two treatment agents in a* 

*Mixed clear cell and endometrioid carcinoma arising in parietal endometriosis.* Gynecol

*rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8-tetrachlorodibenzo-*

*implantation in an episiotomy scar.* Obstet Gynecol 2007, 110, 467-9.

*literature.* Tech Coloproctol 2010, 14 (Suppl), S25-7.

*the cesarean section scar].* Ginekol Pol 2008, 79, 612-5.

Obstet Gynecol Scand 2007, 86, 73-80.

*rat model.* Hum Reprod 2010, 25, 932-7.

*p-dioxin.* Fundam Appl Toxicol 1993, 21, 433-41.

*endometriosis.* Am J Obstet Gynecol 1940, 40, 549

Obstet Invest 2007, 63, 140-2.

Arch Surg 1925, 10, 1-72.

*report.* J Urol 1980, 124, 722-3.

Gynecol Obstet 2009, 279, 217-9.

Ed: *Via Medica*, Gdańsk, 2010, 24-38.

Gynecol Reprod Biol 2009, 142, 145-8.

Gynecol 2008, 47, 42-8.

83-5.


[22] Gajjar K.B., Mahendru A.A. & Khaled M.A.: *Caesarean scar endometriosis presenting as an* 

[23] de Giorgi V., Massi D., Mannone F., Stante M. & Carli P.: *Cutaneous endometriosis: non invasive analysis by epiluminescence microscopy.* Clin Exp Dermatol 2003, 28, 315-7. [24] Groothuis P.G., Koks C.A. & de Goeij A.F.: *Adhesion of human endometrial fragments to* 

[25] Grümmer R., Schwarzer F., Bainczyk K., Hess-Stumpp H., Regidor P.A., Schindler A.E.

[26] Gupta R.K.: *Fine-needle aspiration cytodiagnosis of endometriosis in cesarean section scar and rectus sheath mass lesions – a study of seven cases.* Diagn Cytopathol 2008, 36, 224-6.

[28] Harry V.N., Shanbhag S., Lyall M., Narayansingh G.V. & Parkin D.E.: *Isolated clear cell* 

[29] Horton J.D., DeZee K.J., Ahnfeldt E.P. & Wagner M.: *Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases.* Am J Surg 2008, 196, 207-12. [30] Kaunitz A. & Di Saint'Agnese P.A.: *Needle tract endometriosis: an unusual complication of* 

[31] Kazakov D.V., Ondič O., Zámečník M., Shelekhova K.V., Mukenšnábl P., Hes O.,

[33] Khoo J.J.: *Scar endometriosis presenting as an acute abdomen.* Aust N Z J Obstet Gynaecol

[34] Kocakusak A., Arpinar E., Arikan S., Demirbag N., Tarlaci A. & Kabaca C.: *Abdominal* 

[35] Korczyński J. & Sobkiewicz S.: *Diagnostyka i postępowanie lecznicze w przypadkach* 

[36] Kurotsuchi S., Iwase A., Goto M., Hariyama Y. & Kikkawa F.: *Scar endometriosis after a* 

[37] Lattuada D.,Somigliana E., Viganò P., Candiani M., Pardi G., Di Blasio A.M.: *Genetics of* 

[38] Leite G.K.C., de Carvalho L.F.P., Koreks H., Guazzelli T.F., Kenj G. & de Toledo V.: *Scar* 

[39] Matsuo K., Alonsozana E.L.C., Eno M.L., Rosenhein N.B. & Im D.D.: *Primary peritoneal* 

*wall endometriosis: a diagnostic dilemma for surgeons.* Med Princ Pract 2005, 14, 434-7.

*laparotomy for uterine perforation as a complication of dilatation and curettage.* Arch.

*endometriosis: a role for the progesterone receptor gene polymorphism PROGINS?* Clinical

*endometrioma following obstetric surgical incisions: retrospective study on 33 cases and* 

*clear cell adenocarcinoma arising in previous abdominal scar for endometriosis surgery.* 

[27] Halban J.: *Metastatic hysteroadenosis.* Wien Klin Wochenschr 1924, 37, 1205-6.

*peritoneum in vitro.* Fertil Steril 1999, 71, 1119-23.

*amniocentesis.* Obstet Gynecol 1979, 54, 753-5.

[32] Kennedy S.: *The genetics of endometriosis.* J Reprod Med 1998, 43, 263-8.

*endometriozy powłok brzusznych.* Ginekol Pol 2001, 73, 358-72.

*review of the literature.* Sao Paulo Med J 2009, 127, 270-7.

Reprod 2001, 16, 1736-43.

2007, 110, 469-71.

134-46.

2003, 43, 164-5.

Gynecol Obstet 2009, 279, 941-3.

Endocrinology 2004, 61, 190-4.

Arch Gynecol Obstet 2009, 280, 637-41.

167-9.

*acute abdomen: a case report and review of literature.* Arch Gynecol Obstet 2008, 277,

& Winterhager E.: *Peritoneal endometriosis: validation of an in-vivo model.* Hum

*adenocarcinoma in scar endometriosis mimicking an incisional hernia.* Obstet Gynecol

Dvořák V. & Michal M.: *Morphological variations of scar-related and spontaneous endometriosis of the skin and superficial soft tissue: a study of 71 cases with emphasis on atypical features and types of müllerian differentiations.* J Am Acad Dermatol 2007, 57,


**6** 

 *Greece* 

Agatha Kondi-Pafitis

**Pathological Aspects of Endometriosis** 

Endometriosis is one of the most enigmatic diseases of the female because its cause and pathophysiology remain poorly understood. Although the histological diagnosis of endometriosis is usually easy to make, there are diagnostic problems in relation to certain aspects such as the atypias and neoplastic alterations of the endometriotic glandular and stromal components and in cases of endometriosis in unusual places the small size of specimens available for histological examination does not aid the correct diagnosis. An effort will be made in this chapter to address the various problems and the most commonly

Endometriosis is the presence of tissue resembling endometrial components outside the uterus. Usually both, glands and stroma are observed but occasionally the diagnosis can be made when only one component is present. Endometriosis is distinct from adenomyosis or endometriosis interna which is defined by the presence of endometrial components in the myometrium. These two entities were linked in the past by common terminology but

Endometriosis is a condition described in European Medical history for over 300 years (Knapp , 1999) and afflicts women in their reproductive years. It is the third leading cause of gynecologic hospitalization in the USA and although the true incidence is unknown, it is estimated that it afflicts about 4-13% of all women in reproductive age,25-50% of women with infertility problems, 5-25%of those that are hospitalized because of pelvic pain,50% of young girls with severe dysmenorrhea and up to 7% of women hospitalized with the diagnosis of pelvic masses(Cramer & Missmer, 2002, Allaire, 2006, Anaf et al, 2000).There is a shift of the time of diagnosis from the late thirties and early forties to the twenties and the cause of this my be extensive use of laparoscopy and delayed childbearing. The use of hormones in menopausal women and obesity may be responsible for the occurrence of endometriosis in postmenopausal age. Most women with endometriosis present some or all of four major problems: infertility, secondary dysmenorrhea, dyspareunia and pelvic pain, but many women are asymptomatic. The intensity of the pain is poorly correlated with the

present different clinical presentation, epidemiologic and etiologic patterns.

**1. Introduction** 

asked questions about endometriosis.

**2. Definition of endometriosis** 

**3. Clinical features of endometriosis** 

*Aretaieion University Hospital Athens Medical School,* 

*presence and activity of immune cells in human ovarian and abdominal wall endometriomas.* Reprod Biol Endocrinol 2006, 4, 41-9.

