Painless umbilical nodule in a nulliparous female – A clinical quandary

Muralidhar A, Gaffoor N, Shetty A

Pdf Page Numbers :- 169-172

Aparna Muralidhar¹, Nidha Gaffoor¹ and Archana Shetty^1,*

¹Department of Pathology, Dr. Chandramma Dayanada Sagar Institute of Medical education & Research, Ramanagara, Karnataka-562112, India

*Corresponding author: Dr. Archana Shetty, Associate Professor, Department of Pathology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER), Devarakaggalahalli post, Harohalli, Kanakapura Road, Ramanagara District Karnataka-562112, India. Mobile: +91 9986577343; Email: archanashetty2924@gmail.com

Received 12 April 2021; Revised 10 June 2021; Accepted 21 June 2021; Published 28 June 2021

Citation: Muralidhar A, Gaffoor N, Shetty A. Painless umbilical nodule in a nulliparous female – A clinical quandary. J Med Sci Res. 2021; 9(3):169-172. DOI: http://dx.doi.org/10.17727/JMSR.2021/9-24

Copyright: © 2021 Muralidhar A et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PDF

Abstract

Background: Endometriosis is a well-known entity most often found within the pelvis and extra pelvic sites like skin, diaphragm, gastrointestinal tract and brain. Primary umbilical endometriosis is a rare form of cutaneous endometriosis, typically presenting as a hyperpigmented umbilical nodule with or without cyclical pain. We present a case of painless umbilical nodule with discolouration in a nulliparous woman, unsuspected clinically with the diagnosis being made primarily on cytology.

Case report: A forty-year old female presented with a painless, brownish discoloured umbilical nodule, which was present since two months, was irreducible and had a negative cough impulse. She had no prior surgeries. Ultrasonography of abdomen and pelvis revealed a hypodense lesion of 2cm in the umbilicus, suggesting a possibility of umbilical granuloma. Uterus showed leiomyomata. Cytological evaluation of the umbilical nodule was suggestive of endometriosis. The patient underwent hysterectomy for leiomyomata and omphalectomy. Histopathology confirmed the diagnosis of umbilical endometriosis supported by the immunohistochemistry marker (CD10) being positive for endometrial stromal cells. The uterus had adenomyotic foci in addition to leiomyomata.

Conclusion: The clinical distinction between primary umbilical endometriosis and other causes of umbilical nodules is challenging. Imaging modalities do not show pathognomonic signs in establishing this diagnosis. A definitive diagnosis is possible on cytology based on classical morphological features with histopathological examination being the gold standard diagnostic modality.

Keywords: endometriosis; endometrial stroma; cytology; immunohistochemistry; umbilicus; nulliparous