Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39-year-old woman who presented with a 13-year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA-125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies.

UNASSIGNED: This report summarizes the characteristics of a series of 8 recent (2020-2022) patients with abdominal wall endometriosis (AWE) who underwent laparoscopic surgery. The feasibility and advantages of laparoscopy in the treatment of AWE are set out.
UNASSIGNED: The clinical data of the 8 AWE patients were retrospectively analysed. Basic clinical characteristics, operation details and postoperative details were collected and analysed.
UNASSIGNED: Laparoscopic treatment was successful in all 8 cases. The mean operation time was 212.13 ± 48.16 min, the mean estimated blood loss was 25.00 ± 11.18 ml, and the mean postoperative hospital stay was 5.25 ± 1.39 days. 7 of the patients were found to have concomitant pelvic endometriosis, and 1 patient was found to have concealed inguinal hernias during surgery. Concomitant laparoscopic surgery for pelvic lesions was performed, including electrocautery or lesion resection of the pelvic endometriosis lesions in 7 patients, uterine fibroidectomy in 2 patients, high ligation of the hernia sac in 1 patient and endometrial biopsy under hysteroscopy in 1 patient. Endometrial-like tissue was confirmed by postoperative pathological examination of resected AWE lesions in all patients. There were no intraoperative or postoperative complications. The mean follow-up time was 18.75 ± 3.96 months, and no recurrence of AWE was found.
UNASSIGNED: Laparoscopic surgery is a safe, effective and feasible treatment option for AWE patients and has the advantages of simultaneous diagnosis and treatment of other pelvic lesions.

Abdominal wall endometriosis refers to the presence of endometrial tissue within surgical scars, most commonly occurring following gynecological procedures such as cesarean sections. This case report presents a rare case of abdominal wall endometriosis in a cesarean scar. The patient, a 32-year-old woman with a history of two previous cesarean sections, presented with cyclic pain and swelling in the lower abdominal region. Physical examination revealed a tender, well-defined mass within the cesarean scar. Surgical excision of the mass was performed, and histopathological examination confirmed the presence of endometrial tissue. This case highlights the importance of considering abdominal wall endometriosis in the differential diagnosis of patients presenting with cyclic pain or swelling in previous surgical scars. Prompt diagnosis and appropriate management can help alleviate symptoms and prevent complications.

UNASSIGNED: The aim of this retrospective study was to investigate the short-term and long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for abdominal wall endometriosis (AWE) and explore its potential influencing factors.
UNASSIGNED: A total of 80 patients with AWE who underwent HIFU therapy were retrospectively analyzed. Follow-ups were also conducted to evaluate the changes in lesion size and pain relief. Multivariate logistic regression analysis was applied to investigate factors influencing HIFU therapy for AWE.
UNASSIGNED: Among the 80 patients with AWE who received HIFU therapy, the effective rates were 76.3%, 80.5%, and 90.5% after 3, 12 and 24 months of follow-up, respectively. Multivariate logistic regression analysis revealed that the AWE lesion diameter and sonication intensity had statistically significant effects on the 3-month and 12-month efficacy of HIFU therapy for AWE, while age, BMI, disease duration, average sonication power and grey-scale changes did not have statistically significant effects. Four patients with AWE experienced recurrence after HIFU therapy, for a three-year cumulative recurrence rate of 6.3%. Furthermore, ten patients required reintervention after treatment, for a five-year cumulative reintervention rate of 13.9%.
UNASSIGNED: This study further confirmed the safety and effectiveness of HIFU therapy for AWE. Factors such as AWE lesion diameter and sonication intensity have been identified as key influencers affecting the short-term and long-term efficacy of HIFU therapy for AWE. The first two years following HIFU therapy constitute crucial periods for observation, and judiciously extending follow-up intervals during this timeframe is advised.

UNASSIGNED: Endometriosis is one of the most frequent gynecologic disorders, clinically confirmed or suspected in one of nine women by the age of 44 years. Its location of occurrence can be classified into intra and extra pelvic. Abdominal wall endometriosis (AWE) is one of its rare location, with frequency of 0.04 to 5.5 %. Furthermore there are only a few cases of AWE in Indonesia that have been reported.
METHODS: Here we present two Indonesian patients at a General Hospital in Tangerang, Indonesia. The first patient, 26 years old, complained of an umbilical mass 2 years after caesarean section. The second patient, 36 years old, complained of an umbilical mass since 8 months, with no history of prior surgery. Both patients had pre-operative ultrasonography (US) and underwent wide local excision. Histopathology examination with presence of endometrial glandular components and endometrial-like stroma confirmed the diagnosis of AWE.
UNASSIGNED: AWE is defined as any endometrial tissue found superficial to the peritoneum, locating most commonly at umbilical, inguinal area, and anterior abdominal wall. Pre-operative diagnostic tools include abdominal ultrasonography (US) or abdominopelvic computed tomography (CT) scan. Since treatment with medications is usually not effective, surgical treatment is recommended, along with confirmation by histopathological examination.
CONCLUSIONS: Diagnosis of AWE should be suspected in all women with symptoms of an abdominal mass and cyclic pain, especially if the patient had history of surgery at the abdominal region. AWE is quite rare, but its symptoms can affect quality of life. Hence, a multi-disciplinary approach is necessary, with the strongly recommended treatment of wide local excision to prevent recurrence and malignant transformation.

OBJECTIVE: Endometriosis of the abdominal wall (AWE) is poorly understood because of its rarity and heterogeneous nature. The aim of this study was to investigate and present the clinical and surgical characteristics of AWE and to propose its classification.
METHODS: This was a multicentric retrospective study. For this analysis, the data from three endometriosis centers were collected. In total 80 patients were included in this study. The Academic Hospital Cologne Weyertal is a certified, level III endometriosis center in Germany with 750-1,000 endometriosis surgeries being performed annually; Barzilai University Medical Center is a certified endometriosis center in Ashkelon, Israel; and Baku Health Center is an endometriosis Center in Baku, Azerbaijan.
RESULTS: The size of nodule (histological specimen) was significant larger in women with than those without adenomyosis (3.34±1.4 vs. 2.55±1.33 cm, p=0.016). The incidence of subfascial involvement was also found to be significantly higher in these women (42% vs. 19%, p=0.03). No significant difference was found in patients with and without obesity. In 78% of cases, the proliferation level (Ki67 marker) was less than 30%.
CONCLUSIONS: AWE has a high prevalence of symptoms such as abdominal wall pain and swelling, as well as bleeding. The strengths of the current study are the investigation of the proliferation marker Ki67 in AWE, the impact of adenomyosis, as well as the suggested classification.

UNASSIGNED: Endometriosis developing in a cesarean section (CS) scar is an unusual event. Malignant transformation arising on the background of scar endometriosis in the abdominal wall is extremely rare. Herein we report a case of clear cell carcinoma (CCC) arising in the abdominal wall from endometriosis tissues following CS and review previous literature.
UNASSIGNED: A 48-year-old gravida 2 para 1 female presented with an abdominal wall mass at her CS scar, which increased in size and became painful in the last 2 years. Physical examination showed a multilocular solid mass of about 13 cm, at the previous CS scar. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12.8cm × 7.7cm multi-septate cystic lesion on the anterior abdominal wall, and histological examination showed that CCC was caused by the transformation of abdominal wall endometriosis (AWE).
UNASSIGNED: An endometriosis-associated malignancy should be considered in the differential with any enlarging mass in the abdominal wall scar.

UNASSIGNED: Abdominal wall endometriosis（AWE）is an unusual extra-pelvic endometriosis. Currently, multiple treatment modalities are available, but no clear guidelines exist for the management of large AWE.
UNASSIGNED: We present a 36-year-old female patient with a large AWE lesion who underwent cesarean section due to abnormal fetal position 8 years ago. The mass lesion of AWE located in rectus muscle fascia and rectus muscle with a size of 61 × 25 × 49mm.
UNASSIGNED: HIFU treatment was completed in one session. One day post-HIFU MRI showed the mass was completely ablated. After HIFU treatment, the cyclical abdominal pain disappeared. The mass lesion shrank during follow-up period and disappeared in 1 year after HIFU. No complication was observed after HIFU.
UNASSIGNED: Surgical resection of AWE remains the standard of care. In patients with large AWE lesion located in rectus muscle fascia and rectus muscle where the muscle and fascia must be excised, HIFU treatment should be considered to avoid mesh implantation.

BACKGROUND: Abdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT.
METHODS: A healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient\'s post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected.
CONCLUSIONS: The current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis.
CONCLUSIONS: Since AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.

OBJECTIVE: The scar of cesarean section (CS) is the most common site of abdominal wall endometriosis (AWE), whose tumor degeneration has been reported in an increasing number of cases; the most frequent histological type is clear cell carcinoma (CCC).
METHODS: We conducted a systematic research of the literature, collecting data regarding the evidence on tumor degeneration from AWE after CS. Moreover, we reported a case of clear cell borderline tumor (CCBT) originating from AWE.
RESULTS: We included data of 37 patients with diagnosis of CCC. The average time between the last CS and the diagnosis of CCC was around 15 years. Overall, 26.0% and 73.9% patients received exclusive local abdominal resection of the lesion and additional surgery, respectively. Lymph nodes involvement was detected in 26.0 % patients and adjuvant chemotherapy was administered in 52.0 % cases. During follow-up period, 15.2% patients died of disease, 32.6% had no evidence of disease, and 17.4% recurred. We diagnosed a CCBT arose in a patients with AWE and a personal history of several surgical procedures for endometriosis, a CS and a subsequent transverse laparotomy. We performed an open bilateral ovariectomy and a large excision of the endometriotic abdominal lesion.
CONCLUSIONS: Tumor degeneration from AWE seems to be a real occurrence with an increasing number of events. Considering the lack of risk factors and diagnostic instruments for tumor degeneration, the removal of AWE localization could be advisable, even though there was long average time between the trigger surgery and the tumor finding.