Umbilical endometriosis

Case contributed by Henry Knipe


Abdominal wall lump.

Patient Data

Age: 35 years
Gender: Female

Patient scanned in decubitus position for comfort. Supraumbilical nodule, which is heterogeneous on T1, high on T2FS and demonstrates enhancement on T1C+FS sequences. It abuts the rectus sheath but there is no extension into the peritoneal cavity. 

Just superior to the umbilicus is an avascular, irregular hypoechoic mass with posterior acoustic shadowing.

The patient proceeded to ultrasound guided percutaneous core biopsy. 


MACROSCOPIC DESCRIPTION: "Abdo Bx core": Five white and brown needle cores between 2 & 15mm.

MICROSCOPIC DESCRIPTION: The fragments consist mostly of vascular but mature fibrous tissue. Scattered amongst this tissue are proliferative endometrial glands with underlying endometrial stromal tissue. There is no evidence of malignancy.

DIAGNOSIS: "Abdo Bx core": Endometriosis.

Case Discussion

Umbilical endometriosis has been reported as both primary (i.e. spontaneous) and secondary (e.g. secondary to laparoscopic surgery). This patient did not report a history of surgery and examination did not reveal any surgical scars. This may be a case of primary umbilical endometriosis, although this is a very rare diagnosis with <50 cases published in the literature. 

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