Munawar Hussain, Khursheed Noorani.
Primary umbilical Endometriosis - A rare variant of Cutaneous Endometriosis.
J Coll Physicians Surg Pak Jan ;13(3):164-5.

A case of primary umbilical endometriosis is being reported here, who presented with a dark brown nodule on the umbilicus with black pigmentation around it for the last seven months, associated with cyclical pain and bleeding from the nodule. Wide local excision of the nodule, laparoscopic tubal ligation and visualization of pelvic cavity was performed, revealing no sign of pelvic endometriosis. Histopathology report showed endometrial glands with stroma in the excised nodule.

Case Report: A 37 years old lady, married for twenty years, para 8+0, was referred from surgical out patient department with seven months history of a small dark brown nodule at umbilicus which used to bleed and was painful during every menstrual cycle. Pyogenic granuloma or omphalocele, was suspected but she was referred to the gynaecology out patient department to rule out umbilical endometriosis. There was no history of dysmenorrhoea, dyspareunia or chronic pelvic pain and her medical and surgical history was unremarkable. On examination there was a 2 x 1 cm dark brown nodule at umbilicus surounded by brownish tiny nodules. It was slightly tender and cough impulse was not demonstrable which ruled out omphalocele. Laboratory work up and ultrasound of pelvis were normal. Wide local excision of the nodule was performed and as the patient wanted to have tubal ligation, therefore laparoscopic tubal ligation and visualization of the pelvic cavity was also performed. There was no sign of pelvic endometriosis at the time of laparoscopy. Patient made rapid uneventful recovery and was discharged on second postoperative day. Histopathology report of this case revealed skin and underlying fibrocollagenous tissue in which endometrial glands and stroma was visible having appearance consistent with secretory phase of the endometrial cycle.

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