Umbilical endometriosis, also known as Villar’s nodule, is defined as an ectopic localization of functional endometrium at the umbilicus. It is rare, with an incidence ranging from 0.5 to 1.2% of all patients with endometriosis. Clinically, it presents as a solitary, solid, well-defined nodule, colored in red, blue, or black, occasionally accompanied by bleeding and cyclic dysmenorrhea. Its treatment can be medical or surgical, involving analgesics and hormonal suppression using Gonadotropin-Releasing Hormone (GnRH) analogs, hormonal contraceptives, danazol, or progesterone. Surgical treatment involves complete resection of the umbilical lesion. This disease often poses the challenge of differential diagnosis with Sister Mary Joseph’s nodule. It is also a cause of couple infertility. Despite the clinically recognized association between endometriosis and infertility, the mechanisms involved in infertility associated with endometriosis are not fully understood. Umbilical endometriosis is a rare localization of the disease. It is in this context that we report a case. He was a 34-year-old homemaker who presented to the clinic with umbilical pain persisting for 2 years, followed by a painful swelling at the umbilicus 8 months later6-. She reported pain associated with menstruation for the past 4 months, with bright red bloody discharge occurring with each menstrual cycle, subsiding a few days after the cycle. She had been taking analgesics routinely for the pain, but the persistence of bleeding with each cycle prompted her to seek medical attention. The patient had a history of ectopic pregnancy 10 years ago and had a history of 3 pregnancies, 1 live birth, and 2 spontaneous miscarriages. Primary umbilical endometriosis, also known as Villar’s nodule, is a rare but often confusing pathology with other tumorous dermatoses of the umbilicus. Its management always involves a multidisciplinary approach.

• Endometriosis;

• Umbilical;

• Primitive;

• Bamako

Guindo B, Tall K, Kitha P, Keita A, Dissa L, et al. (2024) Umbilical Endometriosis: About a Case at the Dermatology Hospital of Bamako. J Dermatolog Clin Res 12(3): 1166

Umbilical endometriosis, also known as Villar’s nodule, is defined as an ectopic localization of functional endometrium at the umbilicus [1]. It is rare, with an incidence ranging from 0.5 to 1.2% of all patients with endometriosis. Clinically, it presents as a solitary, solid, well-defined nodule, colored in red, blue, or black, occasionally accompanied by bleeding and cyclic dysmenorrhea. Its treatment can be medical or surgical, involving analgesics and hormonal suppression using gonadotropin-releasing hormone (GnRH) analogs, hormonal contraceptives, danazol, or progesterone. Surgical treatment involves complete resection of the umbilical lesion. This disease often poses the challenge of differential diagnosis with Sister Mary Joseph’s nodule [2- 6]. It is also a cause of couple infertility. Despite the clinically recognized association between endometriosis and infertility, the mechanisms involved in infertility associated with endometriosis are not fully understood. Endometriosis is a multifactorial and systemic disease with direct and indirect pleiotropic effects on reproduction. Umbilical endometriosis is a rare localization of the disease. It is in this context that we report a case [7-10].

The patient was a 34-year-old homemaker who presented to the clinic with umbilical pain persisting for 2 years, followed by a painful swelling at the umbilicus 8 months later. She reported pain associated with menstruation for the past 4 months, with bright red bloody discharge occurring with each menstrual cycle, subsiding a few days after the cycle. She had been taking analgesics routinely for the pain, but the persistence of bleeding with each cycle prompted her to seek medical attention. The patient had a history of ectopic pregnancy 10 years ago and had a history of 3 pregnancies, 1 live birth, and 2 spontaneous miscarriages. She had no history of atopy, no contraceptive use, did not smoke, and did not consume alcohol.

On examination, there was noted an oval-shaped hyperpigmented tumor mass measuring 3x5 cm in diameter with a bosselated surface, ulcerated in some areas and well-defined borders, occupying the entire umbilical region. The surrounding skin appeared normal (Figures 1,2).

Figure 1: Villar’s nodule at Day 0 of consultation

Figure 2: Villar’s nodule at Day 14 of consultation

Given this presentation, the diagnosis of primary umbilical endometriosis was established. Abdomino-pelvic ultrasound revealed the presence of a parietal umbilical nodule with ultrasound features suggestive of an endometriotic nodule; however, histopathological examination was not performed. The patient was referred to gynecology for further management.

Argument

Due to its rarity, umbilical endometriosis should be considered as a differential diagnosis in patients presenting with umbilical lesions associated with menstrual cycle pain. Endometriosis typically presents in the pelvic region, but extragenital endometriosis can occur in almost any other organ. Umbilical endometriosis can be divided into primary and secondary presentations, occurring in women without and with umbilical scars, respectively. The common clinical presentation includes periodic pain, swelling, and bleeding. Typically, umbilical endometriosis presents as a rounded tumor that may partially or completely occupy the umbilical scar with intermittent bleeding. Characteristically, the mass increases with the menstrual cycle, becoming more prominent and usually harder, associated with cyclic pain. Its pathogenesis remains uncertain. Clinical diagnosis is challenging, and umbilical endometriosis can easily be confused with other conditions such as benign and malignant tumors. Ultrasound examination is useful, and surgical excision is the treatment of choice. Several cases of malignant transformation have also been described. Villar’s nodule is a condition often diagnosed by dermatologists, with patients often presenting when pain exacerbates or when the nodule begins to bleed, as was the case with our patient. Its management is multidisciplinary, with the gynecologist leading the care since it is a continuum of a gynecological pathology.

Primary umbilical endometriosis, also known as Villar’s nodule, is a rare but often confusing pathology with other tumorous dermatoses of the umbilicus. Its management always involves a multidisciplinary approach.

Conflicts of Interest

None.

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