An umbilical nodule with cyclical changes

Fig 1 Abdominal region with umbilical haematoma during menses Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Primary malignant umbilical tumours (such as melanoma, basal cell carcinoma, squamous cell carcinoma, myosarcoma) are rare, representing only about...

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Bibliographic Details
Published in:BMJ 2011-09, Vol.343 (sep22 1), p.d5855-d5855
Main Authors: Möhrenschlager, Matthias, Arbogast, Helmut P, Henkel, Verena
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Basal cell carcinoma
Case reports
Cysts
Diagnostic tests
Endometriosis
Endometriosis - pathology
Family medical history
Female
Hernias
Humans
Hysterectomy
Medical imaging
Melanoma
Metastasis
Middle Aged
NMR
Nuclear magnetic resonance
Pain
Patients
Primary care
Progestin
Tomography
Tumors
Ultrasonic imaging
Umbilicus
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Summary:Fig 1 Abdominal region with umbilical haematoma during menses Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Primary malignant umbilical tumours (such as melanoma, basal cell carcinoma, squamous cell carcinoma, myosarcoma) are rare, representing only about 20% of all malignant umbilical tumours, with the remainder being metastatic. 19 Most often, filiae of an adenocarcinoma are found, but metastases from sarcoma, mesothelioma, melanoma, and others have also been detected. 20 Non-malignant umbilical tumours include lipoma, lipoleiomyoma, abscess, cyst, hernia, granuloma, and keloid. 21 22 Congenital malformations of the omphalomesenteric duct or urachus must also be considered. 19 3 Which diagnostic procedure(s) would be appropriate? Courtesy of Doris Mayr, Institute of Pathology, Ludwig-Maximilians University, Munich, Germany) A single dermoscopy study on cutaneous endometriosis mentions the pathognomonic sign of "red atolls," which was not present in our patient. 24 If pelvic manifestations of endometriosis are suspected, gynaecological examination, vaginal ultrasound, and laparoscopy may help to exclude the diagnosis or locate and remove tissue. 1 16 The value of the serum CA125 concentration in the diagnosis of endometriosis has been debated. 25 4 What kind of treatment would you recommend? Long answer In umbilical endometriosis, a complete wide local excision is the treatment of choice. 2 3 14 In severe cases or in the presence of pelvic endometriosis, hormonal treatment aims to reduce the symptoms of endometriosis by suppression of luteinising hormone and follicle stimulating hormone. 3 In this context, gonadotrophin releasing hormone agonists and other agents (including oral contraceptive pills, progestins, and synthetic androgens) have been used to induce atrophy of endometrial tissue. 1 14 16 26 27 Patient outcome Excision of the lesion with accompanying umbilical reconstruction proved successful.
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.d5855