子宮內膜異位症表現模擬臍尿管腫瘤
周主民、周詠欽、鄭明進、沈正煌、林昌德
嘉義基督教醫院 外科部 泌尿科
Endometriosis Mimic Urachal Tumor
Chu-Min Chou, Yeong-Chin Jou, Ming-Chin Cheng, Cheng-Huang Shen, Chang-Te Lin
Divisions of Urology, Department of Surgery, Chiayi Christian Hospital
A 43-year-old female presented to the outpatient urology clinic with incidental abdominal Computed Tomography revealed a soft tissue mass between the lower midline of the abdomen and the bladder dome; urachal tumor was highly suspected. Her medical history was notable for laparoscopic appendectomy for acute appendicitis 2 years earlier; she had neither hematuria nor urinary symptoms. A palpable solid mass in lower abdomen without tenderness was discovered during physical examination. Cystoscopy showed smooth bladder mucosa without tumor invasion and random biopsies were performed, which showed chronic inflammation and polypoid change. Excision of the tumor with adequate safe margin from abdominal wall and partial cystectomy were performed. The diagnosis of histopathological analysis revealed endometriosis involving both the urinary bladder muscle layer and abdominal wall. It’s a very rare presentation of endometriosis, as the mass between the urinary bladder and lower midline of abdominal wall closely resembled urachal tumor. The post-operative course was uneventful and no recurrence at the 6-month follow-up.
Endometriosis is well-known for its wide distribution in human body and diverse presentation. Most of the patients experienced symptoms related to menstrual cycle, however, only non-specific symptoms and signs were found in our case. Diagnosis of endometriosis can be challenged without typical presentations and locations. In challenging cases, the diagnosis relied on pathologic proof after surgical resection as in our case. No similar presentation was reported in database search. We believed this report could help to raise awareness of differential diagnosis of endometriosis in tumor mimic urachal origin.