Adenomyosis of the Extrapelvic Portion of the Round Ligament

Background: Adenomyosis is a disease of the uterus characterized by invasion of endometrial cells within the myometrium. Adenomyosis is typically confined to the uterus, with no distant localizations. This article reports on a case of adenomyosis of the distal extrapelvic portion of the round ligament. Case: The patient, a 49-year-old woman, had previously undergone surgery for pelvic endometriosis. This prior surgery included removal of uterus, fallopian tubes, and a portion of the sigmorectal intestine. She then presented with a nodule on the right side of her pubis. The nodule was close to the upper part of her right labia majora. She was experiencing cyclic pain, nodule enlargement, and edema on the right side of her pubis. The entire round ligament, from the internal inguinal canal to its distal end above the pubis, was removed. Histology testing revealed that the distal nodule was a myomalike neoformation containing endometrial tissue; this was definable as adenomyosis. Results: After the surgical procedure, the patient recovered quickly and after 6 months she was still free of symptoms. Conclusions: To the current authors' knowledge, this is the first case describing such a distant migration of endometrial cells up to the final extraperitoneal end of the round ligament to form a nodule of adenomyosis. A physical examination and imaging should be performed to rule out hernia, a cyst of the Nuck's duct, or lymph-node enlargement. Complete excision is curative

Background: Adenomyosis is a disease of the uterus characterized by invasion of endometrial cells within the myometrium. Adenomyosis is typically confined to the uterus, with no distant localizations. This article reports on a case of adenomyosis of the distal extrapelvic portion of the round ligament. Case: The patient, a 49-year-old woman, had previously undergone surgery for pelvic endometriosis. This prior surgery included removal of uterus, fallopian tubes, and a portion of the sigmorectal intestine. She then presented with a nodule on the right side of her pubis. The nodule was close to the upper part of her right labia majora. She was experiencing cyclic pain, nodule enlargement, and edema on the right side of her pubis. The entire round ligament, from the internal inguinal canal to its distal end above the pubis, was removed. Histology testing revealed that the distal nodule was a myomalike neoformation containing endometrial tissue; this was definable as adenomyosis. Results: After the surgical procedure, the patient recovered quickly and after 6 months she was still free of symptoms. Conclusions: To the current authors' knowledge, this is the first case describing such a distant migration of endometrial cells up to the final extraperitoneal end of the round ligament to form a nodule of adenomyosis. A physical examination and imaging should be performed to rule out hernia, a cyst of the Nuck's duct, or lymph-node enlargement. Complete excision is curative. (J GYNECOL SURG 32:204)