ENDOMETRIOSIS OF THE VULVA AND PERINEUM
Keywords:endometriosis, episiotomy, perineum
Introduction: Endometriosis of the vulva and perineum (EVP) refers to rare forms of extragenital endometriosis and is described in the specialized literature as separate clinical observations or in small series.
The purpose of the study was to analize the features of diagnosis and treatment, as well as the morphological characteristics and immunohistochemical profile of EVP.
Materials and methods: A retrospective analysis of a database of 38 cases of endometriosis in the area of postoperative scars was performed. Used: ultrasonography and Doppler (USG and D), morphological and immunohistochemical methods.
Results: 8 (21.6%) cases of EVP were found, the average age of the patients was 29.4±2.1 years (95% CI:24.63–34.12). The main clinical manifestations of EPV: (1) the presence of volumetric mass in the external genitalia field; (2) catamenial (n=6) or persistent pain (n=2) in the mass area; and (3) an increase of the mass (n=6) on the precycle or during the cycle period. In all cases, a case history of surgical interventions in the area of the external genitalia was noted: episiotomy (n = 5), suturing of gaps in childbirth (n=2), and removal of the labia cyst (n=1).
On palpation, EVP were defined as a solid, relatively mobile mass, painful during compression. In the vast majority of cases, single endometriomas were noted and in only one – two ectopias. Endometriomas were localized in the perineum (n=5), in the labia (n=2) and in the posterior wall of the vagina (n=1). With USG and D: EVP were visualized in the form of hypogenic mass, with hyperechoic contours and varying degrees of peripheral vascularization. In all cases, the excision of the EVP within the unchanged tissues was performed, maintaining the integrity of the endometriomas.
A pathomorphological study, in all cases, confirmed the diagnosis of EVP (endometrial glands and adjoining cytogenic stroma). An immunohistochemical study: CD10 – diffuse (+++) membrane expression in the cytogenic stroma; cytokeratin 7 – intense cytoplasmic expression in the endometrial glands; progesterone receptors – intense nuclear expression in the cells of the endometrium and cytogenic stroma (92-99%, Allred index 7.8); estrogen receptors – expression in the nuclei of the endometrial glands and cytogenic stroma (95%, Allred 3 index). Patient follow-up periods averaged 31.9±4.1 months (95% CI:21.86–41.85), no recurrence of EVP was detected (zero).
Conclusions: EVP is a rather rare form of extrapelvic endometriosis. In most cases, EVP develop after surgical interventions in this area (episiotomy). Surgical treatment with R0 resection is the method of choice for this pathology.