Abstract:

Endometriosis is a benign condition of endometrial tissue outside of the uterine cavity, affecting 10-15% of women of reproductive age. Typically, lesions present on intrapelvic structures. Less commonly, extrapelvic sites are affected, including the skin, and rarely the umbilicus. Cutaneous endometriosis of the umbilicus represents approximately 1% of extrapelvic cases. We report a case of cutaneous endometriosis arising in the umbilicus in a 21-year-old G1PO female with a history of ovarian cysts and regular menses. The patient presented with a two-year history of swelling, pain, and darkening of the umbilicus that worsened with menstruation. On examination, there were three hyperpigmented nodules of the umbilicus with periumbilical erythema that was tender to palpation. Recent imaging of the abdomen and pelvis revealed a 2x2cm soft tissue prominence of the umbilicus without intraabdominal/pelvic abnormalities identified. A tangential shave biopsy of the umbilicus was performed. Grossly, the specimen revealed a white surface with foci of brown hemorrhagic material. Histopathologic examination revealed an unremarkable epidermis. Glandular spaces lined by pseudostratified columnar epithelium within a loose concentric fibromyxoid stroma containing extravasated red blood cells were identified within the dermis, consistent with a diagnosis of cutaneous endometriosis. This case highlights the importance of recognition of cutaneous endometriosis. Biopsy will confirm the diagnosis and eliminate other potential etiologies of cutaneous umbilical lesions. It is recommended to assess the patient for intrapelvic endometriosis, as this is observed in 25% of women with umbilical endometriosis. Surgical excision with wide margins is recommended.

Financial Disclosure:
No current or relevant financial relationships exist.

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Caitlin Purvis, BS