#ovarian mass

[crystaivf]

Symptoms of Chocolate Cysts

A chocolate cyst, also known as an endometrioma, is a type of ovarian cyst filled with old blood resembling chocolate syrup. It occurs due to endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus. These cysts can cause pelvic pain, especially during menstruation, and may affect fertility. Treatment options include pain management, hormonal therapy, or surgical removal, depending on the severity of symptoms and fertility concerns. Regular monitoring and medical intervention are essential for managing chocolate cysts effectively.

Chocolate Cysts Symptoms

Here’s a list of symptoms that you may encounter: 

Painful, crampy periods

Pelvic pain not related to your menstrual cycle

Irregular periods

Pain during sex

Infertility for some women

Learn more about Chocolate Cysts Causes symtoms and treatment

[greenishness]

It's honestly so crazy that most women I know who have used hormonal contraception at some point are like yeah I begged my doctor to find an alternative because it made me want to kill myself lol . How can we send people to the moon but not think of a better pregnancy prevention method than pills that make you clinically depressed

[yrfemmehusband]

Female reproductive health terms you should know!

(terfs not welcome)

Dysmenorrhea: Period pain that isn't normal, i.e. any pain more than Mild cramping.

Dyspareunia: painful intercourse

Oligomenorrhea: lighter, shorter menstrual flow.

Menorrhagia: heavier, longer menstrual flow.

Ovarian cysts: a mass on or in one's ovary, can be resolved on its own, or can remain and cause complications such as a rupture.

Polycystic ovary syndrome: a chronic condition causing cysts to reoccur on the ovaries and enlarging them. Symptoms include:

Irregular periods

hormonal imbalance

facial hair

weight gain

painful periods/ ovulation

infertility

People with PCOS are at higher risk for endometrial cancer, type II diabetes heart problems and high blood pressure.

Endometriosis: A chronic condition in which a tissue similar to, but different than, the endometrial lining grows outside of the uterus instead of inside. During menstruation this tissue sheds and has nowhere to go, thus irritating surrounding organs.

Symptoms include:

Irregular periods

Dysmenorrhea

Widespread pain

Painful ovulation

Vomiting, fainting, chills, sweating, fever and brain fog during menstruation

Infertility

Severe bloating

This also puts people at a higher risk for endometrial and ovarian cancer. There are four stages to Endo as it is a progressive disease, with 3/4 being more severe. The average time it takes to be diagnosed is 7 years.

Adenomyosis: A chronic disease similar and comorbid to endometriosis in which a tissue similar to the endometrial lining grows inside of the uterine wall. Symptoms are nearly identical to endometriosis but more difficult to detect.

Many people are diagnosed post menopause, by fault of the medical system, but it can and does develop much before then.

Ovarian cancer: cancer of the ovary(ies).

Endometrial cancer: cancer of the endometrium, the inner lining of the uterus.

Endometrial cyst, or chocolate cyst: cystic lesions from endometriosis.

Tilted uterus: the uterus is positioned pointing towards the back or severely to the front of the pelvis instead of a slight tilt towards at the cervix. Can cause painful sex and periods.

Pelvic floor dysfunction: inability to control your pelvic muscles. Comorbid with many things and is highly comorbid with endometriosis. Can cause pain and incontinence.

Vulvodynia: chronic and unexplained pain at the opening of the vagina.

Interstitial cystitis: a chronic condition where cysts form on the inside of the bladder and urinary tract and cause symptoms similar to that of a UTI.

Pre-eclampsia: a condition occurring in pregnancy where the blood supply between the fetus and the pregnant person is affected and can cause irregular blood pressure, swelling, and in more severe cases headache, nausea and vomiting, a burning sensation behind the sternum, shortness of breath and potentially death if untreated.

Endometritis: an infection or irritation of the uterine lining. Is not the same as endometriosis and is treatable but can cause pain, bleeding, swelling, general discomfort and fever, and more.

Pelvic inflammatory disease: an infection of the reproductive organs

Ectopic pregnancy: a pregnancy that is attached to the outside of the uterus. Can be fatal if left untreated.

There are many more I could probably add but if you see something missing, please add it!

[thecatspasta]

Bc I need a full list of the limb adjacent Arthur Lester blogs I am making one that will be updated as I discover more

If you find this post as a reblog pls check to og post before suggesting a blog. Ctrl f is your friend. Ok lets go

Arthur Lesters:

Right arm (og)

Left arm (sequel)

Criminal mind

Paternal instinct

Dead daughter

Receding hairline

Left pinky

Evicted maggots

Ribcage

Cunt (me :))

Clitoris

Tits

Top surgery scars

Hippocampus

Gut

Mental state

Partner

Liver

Whimpering

Will to live

TKiller cells

Scar tissue

Piano

Slutty waist

Small intestine

Irises

Throat

Intestines

Coccyx

Prostate

Trachea

Thighs

Eyes

Canine teeth

Nose

Leg hair

Prefrontal cortex

Dick

Balls

Femur

Gallbladder

Bones

Blood

Metatarsals

Right footsie

Left nostril

Eyeballs

Ass

Perineum

Left kidney

Nipples

Left shoulder

Amygdala

Left knee

Graymatter

Frontal lobe

New pinkie

Entire body

Right ear

Mouth

Canine teeth

Ovarian cyst

Wooden pinkie

Uvula

Veins

Endocrine system

Facial hair

Left foot

Moral compass

Carpal tunnel

Becracked spine

Skull

Missing ear piece

Cock

Broken bones

Middle c key

Injuries

Better half

Appendix

Neck scar

Matted hair

Tummy

Eyebrows

Inguinal masses

Mustache

Knees

Ass hair

Maggot

Nose

Uterus

DID

Better Half

Vocal Cords

Skin

Endometriosis

Others:

Darkthur lesters lost arm

Faroes music box

Faroes Lesters bathwater

Faroes lungs

The butchers hat

Larsons shattered eyeballs

Johns left foot

Johns right foot

Johns eldritch eyes

Fausts sharp femur

Mr fausts femur

Yellows top left tentacle

Yellows tentacock

Oscars hammer

Father Oscars left arm

Kaynes bare grippers

Kaynes canines

Parkers closeted corpse

[mindblowingscience]

If it weren't for the careful eyes of an excavator, working at an ancient underground tomb in Egypt, archaeologists may never have found it: a lonely tooth, nestled in the curve of a worn-down pelvis. At first, site supervisor and archaeologist Melinda King Wetzel thought she was looking at a fetus from the time of the Egyptian pharaohs. But when she showed the grave to the bioarchaeological director of the site, Gretchen Dabbs, the discovery turned out to be even rarer in nature. Along with another site supervisor, Anna Stevens, Wetzel and Dabbs claim to have found the oldest evidence of a mature ovarian teratoma, or germ cell tumor. Today, the mass looks like a calcified clump of disorganized and fully formed tissues, like bone and teeth.

Continue Reading.

[fangirleaconmigo]

So I’ve been a bit absent. Putting a ‘read more’ because shit in my life has gotten very real very quickly.

One of my younger sisters went to urgent care with stomach discomfort last Tuesday. It turned out that she had a huge mass in her pelvis, (18x25 cm) and our lives were plunged into a black hole of fear.

In the past week/weekend, she’s gotten blood tests and referrals for more scans. Every test result is more ominous and terrifying than the last. It is definitely ovarian cancer and she will need a major surgery and we don’t know what else.

In one day, I moved her completely into my house. She gave notice on hers. We are trying to find foster care for her cats while she is in treatment because she can’t care for them during, and neither can I.

We still haven’t had a proper prognosis and treatment plan. That will be today, I hope. I am about to drive her to her first actual appointment with a real oncologist.

It’s early and I’m lying awake in my bed. I haven’t slept much in the past weeks. I go to sleep googling ovarian cancer, and I wake up and google ovarian cancer, and I feel like an entire house is crushing me. I can barely breathe. I have to go fetal position for a few minutes sometimes during the day to get through it.

We need some hope today. We need some good news. We need, at the very minimum, a plan for her care. Something to focus on.

Please keep us in your thoughts and send us some love and good will. She is either in shock or being very brave but she could get hopeful, or devastating news today (or more terrifying limbo) and I don’t know where that will leave us.

I won’t try to tell you how much my sister means to me. But I will say that we grew up together in an isolated family with shitty, monstrous, abusive parents and it fused us together in profound ways. I raised her to the extent that a child can raise another child. (It’s like that John Mulaney joke where he said his babysitter was so young, it was like a horse caring for a dog lol)

We are both super sci-fi fantasy nerds. I watch tv with her probably three to four nights a week, and we can talk for LITERAL HOURS about the intricacies of the writing and the characters on the various franchises. We usually agree, but we probably woke the neighbors with our argument about who the best Doctor Who companion was.

We work at the same hospital and share an office one day a week, and the people in the hall probably hear our elaborate Star Wars or MCU theories.

I know better than to get her started about certain things, but no matter what I do, every Thanksgiving she gives an entire speech about how the LOTR movie adaptations failed Gimli, son of Gloin.

We’ve been to Supernatural cons (we’ve both written SPN fic), and SDCC together many times. Actually, we went to ECCC together this year, so @spacecores and @roguepyrola met her and can attest to the fact that she is a mouthy, down to earth, absolutely brilliant, funny, foul mouthed, nerdy ass bitch.

I NEED HER, ok, I FUCKIN NEED HER.

So if you meditate, pray, send intentions, I don’t care what it is, I need it today. Her appointment is in about three hours and we need some hope.

Thanks for reading, friends. ♥️ I know this isn’t fandom related but we’re all real life human beings here with real lives, and that’s what is happening in mine.

[transgenderer]

i finished my mole book and immediately ordered another mole book off amazon (just realized i forgot to check if it was on libgen. the first one wasnt. well. whatever. it was 12 bucks). im molepilled. im molemaxxing. some facts from my mole book (moles by rob atkinson). non-indented mine

Vertebrae in the mole's chest region (the thoracic vertebra) can move so that they allow the mole to bend and rotate its chest through angles of up to 90 degrees relative to the lower back, far more than those of the rat which can only reached 15-18 degrees

One mole travelled above ground for more than a kilometer to a stream to a drink, and unerringly all the way back

Mole very occasionally build much larger hills, about a meter long and 30 centimeters tall. Usually there's a nest inside, and an earthworm cache. Scientists aren't sure why they build them. it seems like it's probably for flooding and maybe insulation in thin soil, but even in areas prone to flooding only 5% of moles build fortresses, and in general it's even less. So that's weird. Probably theyre just very expensive to build, so only the healthiest/luckiest moles can afford to build them

Female moles are entirely female with completely normal mating behavior, pregnancy, and birth, but, uniquely among mammals, they have 'ovotestes', rather than simply ovaries. Ovotestes are reproductive organs divided into testicular and ovarian tissue. The ovarian tissue produces the egg and sits on a larger mass of testicular tissue. This testicular tissue does not produce sperm but it does produce testosterone.... Interestingly, the presence of a penis-like clitoris in many moles is not related to the presence of ovotestes since some American species have the former but not the latter.

Outside the breeding season the testicular tissue is active in producing testosterone while the ovarian portion is regressed and the womb flaccid and small. As the breeding season starts, the testicular tissue shrinks, testosterone production reduces, the ovaries become active, and the womb enlarges. As she nears mating time the female develops a transverse, crescent-shaped slit behind her urinary papilla, between it and the anus. This slit opens into the vagina and allows for penetration by the male and mating it closes up, leaving a small scar

Over 50% of the mole population is under 1 year old. The death probability is consistent over time, so mole's have a "half life" of one year, although they've been found up to 7 years old. Their population triples by the end of breeding season, so the vast majority have to die.

When digging beneath snow, moles may, at least temporarily, be unaware of where the soil stops and the snow starts. After the snow has melted, half-tunnels have sometimes been seen at what was once the soil/snow interface, but even more strangely, tunnels have been found running through snow itself! Actually, I think it is possible that a mole breaking out from the soil into the snow may continue digging for some time before realizing there is no food. Snow is much easier to dig tan soil and likely compacts itself into the tunnel walls, leaving little or no residue for the mole to push up into 'snowhills'.

I feel like my big takeaway was that mole life is horribly cheap. like bugs that way. humans make stuff out of their fur despite how small they are. they used to be killed en masse with strychnine although that's illegal now in the UK. kinda sad stuff

[alex51324]

Man, if you want to be pissed off, reading about ovarian tumors is one of the way to get there.

Detecting ovarian cancer early is hard--it's often described as having "no symptoms"--but actually, the symptoms is has are indistinguishable from the symptoms of "having a uterus and ovaries that are functioning more-or-less within tolerances."

One study came to the conclusion that, to improve diagnosis to the point it would save lives, people (with the aforesaid anatomy) would need to get imaging (ultrasound, etc.) done when they have pelvic pain lasting more than two weeks. Christ, is there anyone (with the aforesaid anatomy) that hasn't had pelvic pain lasting more than two weeks?

And then you get into how existing disparities exacerbate this problem. I was on this site called Radiopaedia--it's a free database of imaging case studies--looking at cases with masses similar to mine, and I found this one. This patient was reporting gastrointestinal symptoms for months, and was, eventually--because she was obese--referred for weight-loss surgery.

Once they started doing it, they found an ovarian mass the size of a cantaloupe in her. The case study is light on detail, but it seems pretty likely that she was repeatedly told that if she had an upset stomach, it was probably from eating too much. Nope! It was from having her guts literally rearranged by something the size of a bowling ball. If anyone had taken her situation seriously enough to perform imaging of any kind, it would have been super-obvious.

(Hers turned out to be benign, BTW, so she probably ended up being fine--but a cancerous mass the same size wouldn't have been detected any earlier.)

(Mine, BTW, is a couple of centimeters smaller than that one--it was palpable during a routine physical because I'm fairly slim, and that led to me being referred for imaging.)

Then you get the studies saying, "Well, we could detect a lot more of these things if ultrasound was part of the routine workup for patients with this anatomy, but then we'd be finding a lot of benign functional cysts, too." Yes, and? Why is that a problem? "Well, then patients would expect us to actually do something about their cysts, especially if they're chronic and painful." And? "Well, we really can't be assed."

[bookofjudith]

Apologizing to a friend for not responding to texts because I was in the er with an ovarian cyst and finding out that not only was she also at the doctor for an ovarian mass, hers is triple as big and metastatic is the equivalent of putting on rain boots because you expect a light drizzle and getting slammed with a typhoon

[shoatgeep]

ART FOR DONATIONS

My partner has a large mass on her ovary that has slowly been getting bigger and causes her pain every day. She has to pay $1,300 up front to be able to get the surgery to remove it. She wakes up in tears from pain almost every single day now, and it's really taken a toll on her every day life. It seriously breaks my heart for her to see her hurting so much every day, even when taking pain meds. She's also at risk for ovarian torsion if it doesnt get removed, which would need emergency surgery to correct.

I would seriously appreciate any donations that would help her to be able to afford the out of pocket cost of her surgery so that she can feel better.

https://gofund.me/0bb1db67

I will make a drawing for anyone who donates and shows me a screenshot proving their donation.

It can be your fursona, your pet, an animal you like. Or even yourself or human characters, though I'm not as good at them. I'll draw anything really.

Thank you 💙

[gusty-wind]

Japanese Research Finds “Significant Increases” in Cancer Deaths Linked to 3rd Covid Shot

A recent study by Japanese researchers found that although there were no excess cancer deaths in Japan during the first year of the Covid-19 outbreak, researchers noticed an increase in cancer mortality during the period of mass vaccination. Some excess cancer mortalities were observed in 2021 after mass vaccination with the first and second vaccine doses, and significant excess mortalities were observed for all cancers and some specific types of cancer (including ovarian cancer, leukemia, prostate cancer, lip/oral/pharyngeal cancer, pancreatic cancer, and breast cancer) after mass vaccination with the third dose in 2022. Japan administered Western mRNA COVID shots, 78% were manufactured by Pfizer and 22% were from Moderna.

more…

https://needtoknow.news/2024/04/japanese-research-finds-significant-increases-in-cancer-deaths-linked-to-3rd-covid-shot/

[morallygreyintrovert]

My Terminal Darkness and Me

The doctor asked me to come in, his gentle voice saying this kind of news can’t be delivered over the phone

He says my diagnosis is terminal and I have been plagued with it all my life

The news doesn’t shock me, nor does it instil me with fear, I have know all my life that something was wrong

Voice strong and unshaken, I ask what flavour of tumour I have: lymphatic, thyroid, ovarian maybe?

No not cancer he says, this disease is not something one has, it’s someone one is

Observing my obvious confusion, he holds up a mirror and tells me to look at the lack of light behind my eyes

Some people are born a chromosome short, their hearing impaired but I was born with an absence of light

Looking back, it all makes sense now, my terminal darkness

Why I chased after love I was never able to catch, why I placed my goals impossibly out of reach, thousand of light years away

Hopefully years from now after surviving for as long as I could, I’ll donate my body to science

They will study my blood, my cells; everything that makes me, me

My contribution will lead to medical breakthroughs and a vaccine will be scaled out to the masses

The disease will never be cured for you see, light cannot shine without darkness, the same way life cannot exist without death

But my suffering will have not been in vain, the medicine will make the disease more tolerable

People will adapt and learn to live despite their darkness, they will eventually grow to love and appreciate the mutation for all that it is

But today most are still ignorant and avoidant, for they fear what they do not know and understand

As I walk by them, they dive out of my path and shield their faces

Anxious to be infected and forced to live with my perpetual state of melancholy and despair

So while they turn up their noses in disgust and campaign for my permanent eradication

I will proudly wear my disease as a shinning suit of armour

And oh what a proud solider I will be, because without my terminal darkness and me, there would be no light for all of you to see

[intersex-questions]

In terms of sex, could someone identify as female and intersex? I’m AFAB and wasn’t born with ambiguous genitalia. I got diagnosed with PCOS a couple months ago at age 21, but I’ve had symptoms since puberty. Doctors love to gaslight for years lol. I’ve always had much more body hair and facial hair than most women, hormonal acne, very irregular and painful periods, I don’t ovulate most of the time, and I have ovarian cysts. I think I have an intersex experience but I also grew up being told I was female and that’s usually what I write on medical forms. I think my clitoris is a bit big, but other than that, my vulva and vagina look normal. Is it possible to be intersex and female?

Of course! Intersex is not a gender (although for some people, it may be how they define their gender), nor is it one specific sex. Intersex is simply a spectrum of sex that an individual can be on. Some people think intersex is like a "third" sex, that their is male, female, and intersex. But that's a misconception! Intersex has a wide range of variations, and every single person's experience with being intersex is going to be different. Someone might have a completely "normal " looking vulva and/or vagina and still be intersex. Someone might have a completely "normal" looking penis and still be intersex.

The way I and many others define intersex is somewhere along these lines: An umbrella term to describe individuals who have sex characteristics naturally found in their body that do not fit the societal standard of a traditional standard of a male or female body. These sex characteristics can include but aren't limited to: abnormal puberty, fertility, genitalia, and/hormonal levels.

I have an ask that goes into depth about what "counts" as intersex here.

But basically, sex characteristics doesn't just mean your sex (like your vulva). It can refer to secondary sex characteristics like: body hair, muscle mass/fat distribution, voice pitch, facial hair, and more.

If I was ignoring the fact that you had PCOS, I would immediately say that what you describe sounds like being intersex to me. You show signs of hyperandrogenism ("excess" androgens/masculinizing sex hormones), hirsutism ("excess" body hair beyond what's considered the "standard"), hormonal acne, clitoromegaly (large clitoris) as well as irregular periods.

If I'm accounting for the fact you have PCOS, you just are intersex. The vast majority of intersex people consider PCOS an inherently intersex condition, or, at the least, a condition that can be inherently intersex with symptoms like the ones you describe. The main people saying that PCOS isn't intersex are doctors and perisex people, because counting PCOS as inherently intersex would make the percentage of the population that's intersex go up SIGNIFICANTLY. I believe PCOS is inherently intersex, so I am biased when answering this. But even if one doesn't, most intersex people agree that PCOS can be intersex when symptoms like hyperandrogenism are present. The only people I have ever seen say that intersex requires ambiguous genitalia are perisex people. The intersex community, considering they are intersex, know and understand that being intersex isn't limited to primary sex characteristics.

To go back to your question, yes, you can identify as both female and intersex! You can identify your sex as female and your sex as intersex. You can identify your gender as female and your sex/gender as intersex. Some intersex people who are like you might consider their sex intersex, but others might not! It's an individual choice. People who identify as intersex women, including intersex cis women, absolutely exist and are a large amount of the intersex population.

If you feel the intersex label and community is right for you, you are welcome here. I would consider you inherently intersex because of your PCOS and the symptoms of your PCOS. I hope this helps some!

[sunnywalnut]

Just a quick reminder to the people that doomed us all and our reproductive rights:

Reproductive rights includes anything having to do with reproductive organs.

This includes.

-birth

-stillbirth

-miscarriage(and also abortion where miscarried fetuses have to be removed in order to save the parent carrying.)

-abortion at any time, including within the first 6-8 weeks (when pregnancy shows almost no signs at all, and can even mimic mensuration, which is commonly a 4 week cycle. Bloating, cravings, nausea, swollen breasts, fatigue, etc. All of which are mensuration symptoms as well as pregnancy symptoms. It is also extremely common for a period to take a couple days, if not weeks to show up. Even in people with healthy reproductive organs and relatively regular cycles.)

-failing/painful organs(PolyCystic Ovary Syndrome, Endometriosis, dead uterus/ovaries, cancer, tumors, inhabitable uterus/ovaries that will kill the parent and fetus if a they are not removed, etc etc. And yes. This is a real thing. I have known people who have to live with dead organs inside them because of the government, insurance, and medical practitioner restrictions. Any doctor will tell you that living with a nonworking organ in your body is detrimental to your health. However, they are unable to step in under reproductive laws and restrictions to save lives.)

-inducing labor (including emergency inductions to save both parent and fetus, prevention of hemorrhaging, tearing, and death to parent due to an oversized fetus, or simply being overdue.)

-contraceptives and birth control. Including the pill and sterilization (which people also often use to regulate their cycles. Anyone with PCOS or anything similar who have to deal with full body, joint, and hip pain, extreme blood loss, anemia, iron deficiency, and much more will not have access to healthcare that could literally save them an ER visit or even their lives.)

-trans healthcare(HRT, top surgery, bottom surgery, reproductive organ removal/sterilization, birth control, and much more. Though I do realize that a lot of you who voted in favor of this don't really care about this aspect.)

-maternity care (hemorrhaging, tears, emergency C-sections, emergency labor inductions, epidurals, pain medications, death, etc)

And I am almost 98% sure that this isn't even all of it. Everyone who voted against reproductive rights voted against life.

Plain and simple.

If it were about the children, people would have stepped in to save the lives of those who were forced to carry inviable, unsafe, and deadly pregnancies to term, and to the grave. And in many cases, leaving both parent and fetus dead.

There was never people aborting children after birth. That is called murder and that is illegal for a reason. But they are absolutely not the same, no matter how much misinformation has been spread about the matter.

The lives that have been lost due to the lack of reproductive freedom in this country is large. It is far from finite. And in our society, where rapists can have proof stacked up against them, yet compete in the Olympics, run for president, and continue to make influential moves on the masses, there is no hope for exemption laws. Not even for children.

All of the well meaning people who have been fed lies, wanting to protect the children in need, have failed to hear us in our attempts to illustrate the bigger picture. Despite how much we've tried.

More people are going to die.

Maybe even people you know.

Maybe even you.

But the real question is, what are you going to do about it?

And as always, with large posts like this, my sources:

[jcsmicasereports]

Parietal Endometriosis in Abdominal Wall: Report of Eight Cases by Aymen laaliaoui in Journal of Clinical Case Reports Medical Images and Health Sciences 

Abstract

Parietal endometriosis is a rare clinical entity, occurring after gynecological, obstetrical or abdominal surgery. Sometimes it is primitive. The etiopathogeny remains unclear. 

Material and method: We report eight cases ofabdominal parietal endometriosis occurring in seven cases on laparotomy scars and in one case in a primitive way. 

Discussion and Conclusion: Clinical features include swelling and pain that is rhythmic with the menstrual cycle, but this picture is rarely complete. Medical imaging is of little assistance. Only histological examination of thesurgical specimen will confirm the diagnosis. Surgical treatment is based on the complete removal of the lesions must be large enough to avoid any recurrence. 

Introduction: External endometriosis is an ectopic localization oftissues whose morphological and functional characteristics are those of the endometrial mucosa. It is found in 10 to 20% of women in genital activity. It occurs in about 0.1% of scars from gynecological-obstetrical procedures.[1] On the other hand, in spontaneous skin localizations, it is 0.5%.[2] Diagnosisis relatively easy in women between 20 and 40 years of age with catamenial symptoms. [2] Abdominal parietalendometriosis has been described in various locations including the abdominal wall (rectus abdominis) and umbilicus,[3-4] caesarean section scars,[5-6] skin and adjacent tissue from abdominal or pelvic surgery scars.[7-9] at the site of amniocentesis needle passage.[4] and at laparoscopic trocar ports.[10] Here we report eight cases of parietal endometriosis observed during the last nine years (between 2001 and 2009) in the Gynecology 

Obstetrics Department of the Ibn Rochd Hospital Center in Casablanca. These are young patients (between 34 and 39 years old) with parietal endometriosis on caesarean section scars, apart from one patient who had no previous surgery. 

Patients And Methods: During nine years (between 2001 and 2009), we recorded eight cases of endometriosis of the abdominal wall,including seven cases of parietal endometriosis after laparotomy for gynecological or obstetrical pathology and one case of primary endometriosis, in the Gynecology-Obstetrics "C" department of the Ibn Rochd Hospital in Casablanca. 

Results: The average age of the patients was 37 years (34 to 39 years). Seven patients were married and multiparous,four of them had delivered by cesarean section, three patients had delivered vaginally. One patient was single and had never given birth. The surgical history was marked by the presence of scarred uterus by Caesarean section in four patients, with a tricicatricial uterus in one patient whose last Caesarean section was performed ten years ago with tubal ligation and a bicicatricial uterus in another patient whose last Caesarean section was performed two years ago. In two other patients, the surgical history was marked by a cystectomy for an ovarian cyst of the nature of a sevencentimeter serous cystadenoma in a nulligest patient and by a myomectomy six years ago in two patients. The reason for consultation was paroxysmal pain with premenstrual recurrence at the scar level, without metrorrhagia, urinary or digestivedisorders in seven patients. The evolution was marked by the appearance of a swelling of the laparotomy scar, which was painful, catamenial with a bluish discoloration and gradually increasing in volume in seven patients (fig. 1). These pains appeared on average five years after laparotomy (one to nine years). In the patient with primary umbilical endometriosis, she consulted for painful and itchy umbilical swelling, a symptom that intensified during menstruation. This swelling had been evolving for nine months and was gradually increasing in volume. Clinical examination revealed a nodular mass in the middle of the Caesarean section scar, bluish in appearance and painful on palpation (Fig. 2). The size of the mass varied between20 and 100 mm, with an average of 40 mm. Clinical examination of the patient with a umbilical endometriosis found a tumour two centimetres in diameter which was located in the center of the umbilicus, mobile with respect to the deep, of firm consistency, slightly sensitive to palpation, without any surrounding skin lesion (Fig. 3). Gynecological examination and pelvic touching are without particularities in all cases.

A pelvic and endovaginal ultrasound scan did not reveal images in favour of pelvic endometriotic localizations. On the other hand, at the level of the laparotomy incision, Ultrasonography showed a hypoechoic, heterogeneous, parietal mass with a finely echogenic content averaging 30 mm (Figure 4). The pelvic CT scan was carried out in three patients, and in all cases it showed the presence, opposite the operative scar, at the expense of the skin tissue, of a hypodense formation, rising at the level of its periphery after injection of contrast agent, with discreet infiltration of the periwound fat. The size of the mass on the scanner was 40 mm. In one patient, the pelvic CT scan showed a tissue lesion process, with an anterior and medial parietal site, infiltrating subcutaneous fat and underlying muscle (Figure 5). The surgical procedure consisted of lumpectomy in all cases (Figures 6, 7 and 8). Surgical exploration did not detect any intra-abdominal processes. One patient had received medical treatment with LH-RH analogues for six months, with the aim of reducing the initial nodule size of 100 mm prior to surgery. This treatment resulted in the regression of half of the mass, measuring 50 by 40 mm. In this patient, surgical resection consisted of a subumbilical parietomy with extensive skin sacrifice, anterior fascial sacrifice and muscle sacrifice in the internal third of the rectus abdominis. The repair of the aponeurotic defect,extended over 10/10cm, was performed by sufficient external oblique flaps over 7 cm in the subumbilical area. This repair is reinforced by a plate on the omentum. The skin defect was closed by a T-shaped abdominal plasty, with externalization of the umbilicus. Follow-up at three and six months noted good abdominal tone (Fig. 9). In addition, surgical exploration did not find intra- abdominal processes in seven patients. An open laparoscopic examination was performed in the patient with umbilical endometriosis after removal of the tumour that had taken over the umbilicus (Fig. 10) through the same umbilical excision port. Exploration of the abdominal pelvic cavity allowed verification of the absence of any primary endometriotic lesion. The surgical procedure ended with suture of the sub umbilical fascia and umbilical plasty with creation of a new umbilicus (Fig. 11). Histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases (Fig. 12). Followup of our patients showed no recurrence in seven patients. In one case, two local recurrences on the laparotomy scar had occurred two years apart. The last one was two years ago, when the patient was on progestins and had undergone surgical excision. The postoperative follow-up was simple. With a 14-month to 6-year follow-up, no recurrence was observed, apart from the above-mentioned case.

Discussion: Endometriosis is the ectopic implantation of endometrial tissue. Endometriosis of the abdominal wall is an uncommon pathology and the initial diagnosis is not always easy.[1] It is estimated to account for 0.03 to 2% of extra-genital endometriosis. Only 14.3% to 26% of cases are associated with pelvic endometriosis, in contrast to other atypical implantation sites such as the gastrointestinal tract or the urinary tract.[3] Abdominal parietal endometriosis has been described in various locations including the rectus abdominis.[1,11] the umbilicus. [12] scars from cesarean section, hysterectomy,[3-4] abdominal-pelvic surgery, amniocentesis needle site, laparoscopic trocar ports.[4] Other locations have also been reported, such as the cervix or vulva on episiotomy scars, but never described in the spleen.[4] The presence of isolated endometriosis sites in the umbilicus, rich in lymphatic and venous networks, and in the absence of previous surgery can only be explained by the venous or lymphatic metastatic theory.[1,2] Indeed, it was demonstrated the potential for remote implantation of endometrial glandular cells found in the blood and the migration of contrast material injected into the pelvic cavity towards the umbilicus via umbilical vestigial ducts. Recent work has shown the presence of endometrial tissue in the periumbilical lymphatic system.[4] This entity is rare after menopause.Indeed, at menopause the cytochorionic component regresses but the glandular component may persist. The reactivation of the glandular component under the effect of hormone replacement therapy or in the presence of a secreting adrenal or ovarian tumor (granulosa type) that produces a hyperestrogenic site is known. [1] In the multicenter study of the endometriosis study group,endometriosis of the abdominal wall mainly affects women with genital activity between 20 and 40 years of age.[4] The age of our patients ranges from 34 to 39 years with an average age of 37 years. Elabsi.[1] reports a case of scarring endometriosis in a postmenopausal woman.

Clinically: The clinical manifestation usually corresponds to anodular, inflammatory, persistent infiltration of an abdominal scar. This lesion is painful and catamenial.[4] This infiltrating, nodular, painful and cyclic nature of the lesion was found in all our patients. Frequently, the inflammatory area is associated with serous or serosanguinous discharge, which is exacerbated at the time of menstruation.[4,14] This notion was found in one of our patients. Parietal endometriosis is usually found on Caesarean section scars,[6] which is the case in four of our observations, or scars from gynecological surgery (laparoscopy or laparotomy),[4] as in two of our series. The frequency of endometriotic skin localizations after Caesarean section varies from 0.03 to 0.4%,[6] however, this frequency is much higher than that observed after conventional gynaecological surgery. [4,6] It can occur several weeks or years after surgery.[4] Koger et al.[17] report an interval of 1 to 20 years (mean 4.8 years) between surgery and the onset of symptoms. Zhao. [15] observed a correlation between the latency period and the age of patients at the onset of symptoms. It should be noted that the delay between the causal intervention and the onset of endometriosis is highly variable.[4] It is usually a few months but can sometimes be very delayed, as we observed in one of our observations. In our patients, the delay between the onset of symptoms and the date of obstetric surgery was 5.25 years on average (two to 10 years). The most common modes of disclosure are the discovery of a palpable mass or localized pain in patients with a history of Caesarean section.[4-6] Catameniality, i.e. the exacerbation of these non-specific signs during menstruation, is an important part of the diagnosis.[4] All of our patients were seen for assessment of a parietal mass. This mass was painful with catamenial exacerbation of the symptomatology in all cases, with pain being less predominant in two cases. It should be noted that signs of intra-abdominal pelvic endometriosis were found in only 26% of cases in the literature.[4,9] and none of our patients showed signs of intra-abdominal endometriosis. Thus, the preoperative diagnosis of scarring endometriosis of the abdominal wall can be suspected in the typical form that manifests itself by the presence of a nodule or swelling, purplish blue, painful with brown discharge or hemorrhagic in the period menstrual and catamenial evolution, occurring on a scar most often gynecological. 

Ultrasonography plays an important role in the diagnostic orientation and preoperative assessment, even if it does not allow any formal diagnosis. It confirms the typically intramuscular parietal origin of the suspected mass on clinical examination. It also specifies the size, contours and relationships with adjacent structures.[18,21] The ultrasound aspect of parietal endometriosis is variable. Most often, it is a very limited, hypoechoic, tissue- typical mass. However, the lesion may be cystic, mixed or solid.[20-21] In our cases, a very limited hypoechoic parietal nodule was observed in all patients for whom ultrasonography was performed. Endometriomas can measure between 5 mm and 200 mm.[4,9] Most lesions measure less than 40 mm.[21] In our patients, they measured 30 to 40 mm in diameter in seven cases and 70 mm in one case. The color Doppler ultrasound shows an often highly vascularized mass with dilated afferent vessels. [21] Despite the absence of a specific ultrasound aspect of parietal endometriosis, ultrasound associated with the history of the disease should help to suspect the diagnosis of parietal endometriosis and exclude certain differential diagnoses. The differential diagnoses of a parietal mass on ultrasound are granulomas on scarring, post-operative events, benign tumours and exceptionally malignant tumours such as lymphomas and sarcomas. Granulomas may appear hypoechoic. They sit in contact with the scar. They cannot be differentiated from small wall endometriomas outside a catamenial context. In the case of postoperative echogenicity, echogenicity is variable depending on the contents of the sac, but the clinical examination is often evocative.[18,21] The differential diagnosis of spontaneous umbilical endometriosis is made with an irreducible umbilical hernia, pyogenic or foreign body granulomas, hemangioma, umbilical localization of Crohn's disease or melanoma. But it is especially with umbilical metastases of abdominopelvic tumors, or Sister Mary Joseph's nodule, that this diagnosis must be differentiated, especially in women.[2-5] 

CT and MRI scans can be used to diagnose parietal endometriosis.[20-21] However, most authors report the absence of characteristic signs in imaging because the aspects observed depend on several parameters: distribution between stromal tissue and glandular elements, hemorrhagic character of the lesion and importance of the peripheral inflammatory reaction.[21] The diagnosis was made preoperatively by CT scan in four of our patients, showing an isodense tissue lesional process, anterior and medial parietal, infiltrating subcutaneous fat and underlying muscles. MRI, more than CT scan, is the examination of choice to confirm the diagnosis in case of doubt because it allows to highlight the iron content of the haemosiderin deposits in endometriomas. Observations of parietal endometrioma on MRI are exceptional. MRI is more sensitive than CT for the detection of small lesions.[20-21] The lesion signal is variable depending on whether the lesion is acute,hypersignal T1 and T2 or chronic, heterogeneous signal, and whether there is intra-lesional hemorrhage.[20] MRI was not performed in any of our patients. Thus, although it may be clinically suspected, parietal endometriosis can only be diagnosed by pathological examination of the lesion. Indeed, this is typical and highlights the existence of endometrial glands of varying sizes, often of cystic type, associated with a cytogenic chorion and lymphocyte inflammation. The ectopic situation of these endometrial glands thus corresponds to the diagnosis of external endometriosis. [4,9] Immunohistochemical techniques steroid receptor assays, using specific monoclonal antibodies, find estradiol and progesterone receptors in both the glandular and stroma, but the distribution is very heterogeneous.[4,22- 25] Recent progress in immunohistochemistry has shown that CD 10 is not expressed in glandular epithelial cells in endometriosis, but rather in the stroma, whereas it is expressed in other epithelial cells.[22] In contrast, COX2, a prostaglandin hydroperoxidase, is expressed in the endometrium with production of PGE2 and PGF2α.[22- 23] The combination of estrogen or progesterone receptor antibodies on the nuclei and CD10 or COX-2 antibodies on the cytoplasm may increase the certainty of diagnosis for ectopic endometriosis.[22-25] The treatment of these lesions is based on surgical excision. Surgical excision should be as wide as possible to remove the entire lesion, as the lesion may recur in the event of incomplete excision. It is the only way to confirm the diagnosis by pathological examination and to achieve healing.[1,4-6,29] Surgical treatment remains the most effective, especially since cancerization of parietal endometriosis has been described. [26-27] Indeed, although medical treatment (LHRH agonists or progestins) can improve the symptomatology by reducing the pain and inflammation of the lesions, it cannot bring about a cure and the lesions quickly recur when these therapies are stopped.[28-29] All our patients were treated by surgical excision. One patient had two recurrences for which she had undergone resections. Two patients were treated with LHRH agonists, one preoperatively in front of a 70 mm endometrioma and the second after surgical removal to prevent recurrence.

The surgical procedure can be disruptive, and parietal reconstruction often requires the use of devices such as nonabsorbable thread mesh to reinforce the aponeurotic scars.[6,29] In one of our patients, the repair of the fascial defect, which had spread over 10/10 cm, was performed with sufficient external oblique flaps over 7 cm subumbilically. This repair is reinforced by a plate on the omentum. Prevention may be proposed in patients with pelvic endometriosis lesions, without any evidence of efficacy. It consists of protecting the wall with surgical drapes during Caesarean section, irrigation or pressure saline cleansing of the wall at the end of the Caesarean section.[4,6,29] During the closure of a hysterotomy, it is necessary to ensure the quality of the closure and to put back in place any endometrial invagination, all the more so as the Caesarean section is performed early in the pregnancy.[4,6] 

Conclusion: Parietal endometriosis is an infrequent and often unrecognized condition. Scarring endometriosis must be mentioned in front of any mass sitting on the scar from a gynecological-obstetrical operation. The diagnosis should be made in the presence of pain or a mass in the abdominal wall of a woman during genital activity, especially if this lesion presents catamenial changes and if the patient has a history of gynecological or obstetrical surgery. Color Doppler ultrasound is the morphological examination of choice to confirm the diagnosis and rule out other parietal pathologies by showing a hypervascularized hypoechoic mass. Due to the wide diffusion of CT scans, it is important for radiologists to be aware that these lesions appear as tissue nodules in the vicinity of a scar from obstetric or gynecological surgery. In case of diagnostic doubt before surgery, MRI has a definite place to detect the particular signal of hemorrhage in the endometrioma and confirm the diagnosis. However, the diagnosis is only confirmed by histological study. Healing is achieved by complete excision of the mass.