Clinical differences between adipose- and muscle-layer cesarean scar endometriosis: A retrospective observational
Emre Erdem Taş1,2, Mohammad İbrahim Halilzade2, Melike Doğanay2
1Gynecology and Obstetrics Department, University of Ankara Yıldırım Beyazıt, Ankara, Türkiye.
Background/Aim:
This study evaluated cesarean section scar endometriosis (CSSE) characteristics and compared adipose- and muscle-layer CSSEs.
Materials And Methods:
We analyzed 53 patients who underwent CSSE surgery between 2019-2024, with 38 (71.7%) having adipose-layer and 15 (28.3%) having muscle-layer CSSE.
Results:
Patients' mean age was 33.4 ± 5.9 years. Symptoms began 40.4 ± 23.5 months after cesarean section. CSSE occurred at scar corners in 42 patients (79.2%) and midline in 11 (20.8%). Mean preoperative CA-125 was 24.1 ± 14.8 U/mL. Groups differed in symptoms, location, and CA-125 levels. Adipose-layer CSSE commonly presented with swelling at corners, while muscle-layer CSSE showed pain at midline. Muscle-layer CSSE had higher CA-125 levels (38.2 ± 19.2 vs. 18.5 ± 7.3 U/mL; P = 0.01). The CA-125 cutoff between groups was 30 U/mL. Pain (odds ratio [OR], 7.2; P = 0.03) and elevated CA-125 (≥30 U/mL) (OR, 19.6; P < 0.01) independently associated with muscle-layer CSSE.
Conclusion:
These findings may have important implications in clinical practice, potentially aiding in the localization of undefined lesions, surgical planning, and monitoring of recurrence risk.
