Extrapelvic endometriosis in abdominal wall scar and PPAR gamma expression: A case report

Endometriosis is a frequent gynecological disorder. Its findings on the abdominal wall are rare cases, usually reported with a history of former surgery. The activation of PPARy expression could be one of alternative non-hormonal treatment for endometriosis.

A patient, 34 years old, suspected of endometriosis since 5 years ago because of pain during menstruation. Since the last 4 months, she had worsening of dysmenorrhea and palpable lumps during menses. She had previously performed cesarean section surgeries 3 times and a laparotomy cystectomy due to left endometriosis cyst. From ultrasound examination, on the abdominal wall (submusculus) there is a firmly defined hypoechoic mass, sized 32 × 10 × 15 mm, derived from the mass of endometriosis.

The endometriosis findings on the abdominal wall are rare cases. Symptoms usually are cyclic pain which is also accompanied by a palpable lump. A meta-analysis of 16 studies concluded that sensory excitatory threshold and pain tolerance approached the lowest value shortly before and during menstruation. In humans, administration of PPARy agonists reduced pain symptoms. Counseling to patients is given about the possibility of recurrence.

PPAR expressivity assessment has not been used as a target for endometriosis therapy. Further studies separating epithelial tissue and stroma can be performed to prove the role of PPARγ in the pathogenesis of endometriosis.