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array:22 [ "pii" => "S0210573X23000977" "issn" => "0210573X" "doi" => "10.1016/j.gine.2023.100927" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "100927" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Clin Invest Ginecol Obstet. 2024;51:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0210573X23000965" "issn" => "0210573X" "doi" => "10.1016/j.gine.2023.100926" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "100926" "copyright" => "Elsevier España, S.L.U." 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Camejo, F. Nantes, C. Castillo, D. Centurion, G. Krygier" "autores" => array:5 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Camejo" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Nantes" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Castillo" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Centurion" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Krygier" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X23000965?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000001/v1_202401240434/S0210573X23000965/v1_202401240434/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0210573X23000825" "issn" => "0210573X" "doi" => "10.1016/j.gine.2023.100912" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "100912" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Clin Invest Ginecol Obstet. 2024;51:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Herlyn–Werner–Wünderlich syndrome: A case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Herlyn-Werner-Wünderlich: una serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3267 "Ancho" => 1612 "Tamanyo" => 517616 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(A) Pelvic MR, sequential axial cuts T2: it is identified a uterus didelphys with a longitudinal vaginal septum (arrow). (B) Presence of two hemivaginas. Enlarged left hemivagina and with hyperintense content as regards hematocolpos (arrow). (C) Uterus didelphys (arrow). (D) Arrow shows hyperintense content in the left hemivagina (hematocolpos). (E) Cystic image of the postero-lateral left wall of the bladder regarding the ureterocele (arrow). (F) Left renal agenesis. (G and H) pelvic MR, sequences T2 axial and coronal; uterus didelphys (arrow). (I) Abdominal ultrasound showing the double uterus. (J) Resection of the longitudinal vaginal septum by vaginoscopic.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Castillo Lara, L. De Pablo Zamora, E. Pozuelo Solis" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Castillo Lara" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "De Pablo Zamora" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Pozuelo Solis" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X23000825?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000001/v1_202401240434/S0210573X23000825/v1_202401240434/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Atypical umbilical endometriosis: Microscopic and immunohistochemical characterization" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.P. Marín Sánchez, I. Ñiguez Sevilla, S. Cánovas Sanchis" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.P." "apellidos" => "Marín Sánchez" "email" => array:1 [ 0 => "Ibsyna@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Ñiguez Sevilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Cánovas Sanchis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Obstetrics and Gynecology, ‘Virgen de la Arrixaca’ University Clinical Hospital, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Plástica y Reconstructiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endometriosis atípica umbilical. Caracterización microscópica e inmunohistoquímica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 514 "Ancho" => 755 "Tamanyo" => 70597 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Physical examination: navel with two small and bluish lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Endometriosis is a chronic inflammatory disease dependent on estrogen, which affects primarily the genital tract. However, extra-pelvic endometriosis, such as the cutaneous form,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> represents a small proportion of cases, with umbilical cutaneous endometriosis accounting for 0.5–1% of all cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Although the malignant transformation of umbilical endometriosis is rare, this process remains an enigma, highlighting the importance of precise pathological studies to ensure conservative management.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient information</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 37-year-old Caucasoid woman who consulted for umbilical bleeding coinciding with menstruation. As highlights in her clinical history, the patient was allergic to amoxicillin and was diagnosed with endometriosis. She had undergone surgery 17 years ago, performing a left ovarian quistectomy of an endometrioma using a Pfannenstiel incision (laparotomy). Since then the patient had remained asymptomatic and had not required treatment. She had also had breast reduction surgery 9 years ago. There were no previous umbilical surgical manipulations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">She also presented a history of paroxysmal supraventricular tachycardia with several non-effective attempts at ablation, currently without treatment. The patient suffered episodes of migraine without aura, which did not require treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding her gynecological history, the age of the menarche was at 13 years and her menstruations were cyclic every 28 days, with a duration of approximately 8 days. She had had two pregnancies with two normal deliveries.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among the family history, there was a family aggregation of breast carcinoma (mother, grandmother and two aunts) for which the patient was being monitored by the breast unit.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical findings</span><p id="par0030" class="elsevierStylePara elsevierViewall">Weight 86.9<span class="elsevierStyleHsp" style=""></span>kg, size 1.69<span class="elsevierStyleHsp" style=""></span>m, BMI 30.431<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. On physical examination, two small, bluish lesions were observed in the umbilical scar (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Timeline</span><p id="par0035" class="elsevierStylePara elsevierViewall">The temporal evolution of the clinic and treatment is reflected in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Diagnostic evaluation</span><p id="par0040" class="elsevierStylePara elsevierViewall">A diagnosis of suspected umbilical endometriosis was established. The gynecological examination and ultrasound evaluation were normal. For the umbilical study, a soft tissue ultrasound was performed, due to personal impossibility of MRI. This reported the existence of a hypoechogenic nodule of spiculated contours, of approximately 1.5<span class="elsevierStyleHsp" style=""></span>cm in the umbilical region, which could correspond to endometriosis. Finally, a punch biopsy was taken, with the result of functionally active endometriosis, of dermal location and affected margins.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Therapeutical interventions</span><p id="par0045" class="elsevierStylePara elsevierViewall">With the diagnosis of umbilical endometriosis, the patient started treatment with oral contraceptives, levonorgestrel/ethinylestradiol (100/20<span class="elsevierStyleHsp" style=""></span>μm) in continuous regimen. This treatment kept the patient asymptomatic, but had to be removed 8 months later after an episode of migraine with aura. After its withdrawal, the pain and catamenial bleeding reappeared. We then proposed a surgical approach, performing a resection of the nodule with immediate reconstruction in the operating room, which the patient accepted. A rhomboidal excision with a major horizontal axis was performed, with convex sides toward the diagonals, binding with a suture centered on the crossing of both diagonals and midpoint of each of the sides, thus umbilizing healthy perilesional tissues and thus recreating a new navel.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow-up and results</span><p id="par0050" class="elsevierStylePara elsevierViewall">After surgery, the patient was completely asymptomatic, presenting no complications three months after the surgical intervention. The report of the surgical specimen informed of a piece of 2.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.7<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>cm with a deep dermis lesion showing scattered glandular and cystic formations, some of which were occupied by blood clots, upholstered by a monostratified cubic epithelium, which sits on a rich cellular stroma of non-transformed spiral arterioles. No nucleomegaly or nuclear pleomorphism was observed. There was moderate degree of inflammation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Estrogen receptors and CD10 were positive. Moderate Ki67 (10%) and COX-2 and BAF 250 were present (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The prevalence of malignancy in umbilical endometriosis is estimated to be between 0.3 and 2.8%.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> While all types of carcinomas and sarcomas have been observed in endometriosis, serum and mucinous subtypes are rare, with reported cases of clear cell carcinoma, endometrioid and adenocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the case reported by Obata et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> typical endometriosis, adenocarcinoma and malignant transformation were observed in the same specimen, in accordance with the theory proposed by Sampson and modified by Scott regarding the malignant transformation of endometriosis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Once malignant transformation of extra-ovarian endometriosis has been established, it is possible that atypical endometriosis may serve as a precursor lesion to this transformation, highlighting the need for detailed analysis of such lesions.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Atypical endometriosis is defined by the presence of hyperplasia and/or cellular atypia in ectopic endometrium within endometriosis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> This term also refers to two different histological findings: cellular atypia, or cytologic atypia, and architectural atypia, commonly known as hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There have been reports of atypical endometriosis in scars,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> including a case of atypical endometrial hyperplasia in the ectopic endometrium located in a previous cesarean section incision,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and hyperplastic endometriosis at a cutaneous site.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Leng et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> also describe a case of carcinosarcoma and endometrioid carcinoma arising from an atypical endometriosis in a cesarean section scar.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A new protocol for studying atypical endometriosis has been developed, which includes a histological examination for nuclear stratification, hyperchromatism and pleomorphism for cellular atypia, and the presence or absence of hyperplasia for architectural atypical endometriosis. Additionally, the degree of cell proliferation (measured through immunohistochemical staining for Ki-67 and evaluating the percentage of Ki-67 with nuclear staining of cells), COX-2 as an inflammatory marker, and BAF250a as a surrogate marker of the ARID1A gene mutation were included.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Van den Nouland<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> suggests that atypia or malignancy should be excluded if hypertrophy or decisive changes appear through the expression of cytokeratin7+/keratin20−, estrogenic and gestagenic receptors, and Ki67.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Our clinical report presents a case of atypical architectural endometriosis with moderate degree of cell growth, a moderate presence of Ki-67 (10%). On the other hand, our case has presence of COX-2 and BAF 250, as well as positive estrogenic receptors. These results show an increase in cellular activity, the presence of inflammation, and no mutation of the ARID1A gene.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The presence of atypical architecture or hyperplasia is correlated with a greater degree of cell proliferation, as measured by Ki67, low COX2, and absence of the inflammatory marker BAF250a.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> This indicates that our patient's atypical architectural endometriosis based on hyperplasia and Ki67 marker, in correlation with the data presented, could have an increased risk of malignant transformation.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, although the presence of umbilical endometriosis is uncommon, its malignant transformation is not negligible. Atypical endometriosis should be considered as a premalignant lesion. Our case report highlights the need for a non-dichotomous approach to lesions, incorporating a panel of intermediate immunohistochemical results, which could help to better manage patients with atypical endometriosis.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of people and animals</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experiments have been carried out in humans or animals.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Data confidentiality</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace regarding the publication of patient data.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from the patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Authors’ contribution</span><p id="par0115" class="elsevierStylePara elsevierViewall">The content of the manuscript has not been published or submitted for publication elsewhere.</p><p id="par0120" class="elsevierStylePara elsevierViewall">I confirm that all the authors fulfill the conditions requires for authorship; they have all made substantial contributions and have approved the final version of the manuscript.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Patient consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The patient has given her consent to participate in the presented study.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financing</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no funding.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">There are no potential conflicts of interest of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:18 [ 0 => array:3 [ "identificador" => "xres2078815" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Main symptoms and/or clinical findings" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Primary diagnosis" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Therapeutic interventions and results" ] 4 => array:2 [ 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16 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 17 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-23" "fechaAceptado" => "2023-10-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1773463" "palabras" => array:3 [ 0 => "Umbilical endometriosis" 1 => "Atypical endometriosis" 2 => "Endometriosis-associated cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1773464" "palabras" => array:3 [ 0 => "Endometriosis umbilical" 1 => "Endometriosis atípica" 2 => "Cáncer asociado a endometriosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atypical endometriosis is considered a precursor lesion to cancer associated with endometriosis. Two types of atypical endometriosis have been proposed: an architectural type with a higher risk of malignancy and a cytological type with a lower potential for malignancy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Main symptoms and/or clinical findings</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 37-year-old Caucasian woman presented with umbilical bleeding coinciding with menstruation. On physical examination, two small, bluish lesions were observed in the umbilical scar.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Primary diagnosis</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This clinical case is of interest because it describes a lesion of atypical architectural endometriosis located in the navel.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Therapeutic interventions and results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The microscopic and immunohistochemical characteristics of the lesion were examined. The presence of nuclear stratification, hyperchromatism, and pleomorphism were observed as microscopic qualities. In terms of the immunohistochemical panel, the degree of cell proliferation was analyzed using Ki 67, BAF250a was used as the surrogate marker of ARID 1A, inflammation was assessed through COX, and estrogen and progesterone receptors were examined. The results showed increased cellular activity, the presence of inflammation, and no mutation of the ARID1a gene, with moderate cell proliferation.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Umbilical endometriosis is rare, and while malignancy is infrequent, it is possible. For this reason, a complete anatomopathological study including an immunohistochemical panel should be performed to diagnose atypical endometriosis.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Main symptoms and/or clinical findings" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Primary diagnosis" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Therapeutic interventions and results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La endometriosis atípica está considerada como una lesión precursora de cáncer asociado a endometriosis. Se han propuesto 2 tipos de endometriosis atípica, una arquitectural con mayor riesgo de malignización y otra citológica cuyo potencial de malignización es menor.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Principales síntomas y/o hallazgos clínicos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 37 años caucásica consulta por sangrado catamenial umbilical. A la exploración física se observan 2 pequeñas lesiones umbilicales azuladas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Diagnóstico principal</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este caso clínico es interesante porque se describe una lesión de endometriosis atípica arquitectural localizada en el ombligo.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Intervenciones terapéuticas y resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se ha descrito sus características microscópicas e inmunohistoquímicas para caracterizarla. La presencia de estratificación nuclear, hipercromatismo y pleomorfismo como cualidades microscópicas y en cuanto al panel inmunohistoquímico se ha analizado el grado de proliferación celular mediante el Ki-67, BAF250a como el marcador subrogado del ARID1A, el grado de inflamación mediante COX y los receptores estrogénicos y gestagénicos. Los resultados demuestran que tiene una actividad celular aumentada, presencia de inflamación y no mutación del gen ARID1A con moderación proliferación celular.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La endometriosis umbilical es poco frecuente y su malignización, aunque rara es posible. Por esta razón, se debería realizar un estudio anatomopatológico completo que incluya un panel inmunohistoquímico en aras de diagnosticar endometriosis atípica.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Principales síntomas y/o hallazgos clínicos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Diagnóstico principal" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Intervenciones terapéuticas y resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 514 "Ancho" => 755 "Tamanyo" => 70597 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Physical examination: navel with two small and bluish lesions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1328 "Ancho" => 2473 "Tamanyo" => 311945 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Timeline of clinical evolution and management of the patient.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 284 "Ancho" => 755 "Tamanyo" => 61194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">(A) Hematoxylin–eosin with magnifying glass: a nodule is located within the fibrous tissue revealing an increased number of endometrial glands attached to each other. (B) Ki67 ×100: in the glandular epithelium a moderate cell proliferation index is shown, estimated at 10% of the nuclei.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Architectural atypia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atypia cellular atypia</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleomorphism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nuclear stratification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nucleomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunohistochemical study</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ki 67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate (10%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COX2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAF250a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Estrogen receptors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CD10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3442079.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Histological and immunohistochemical findings of the specimen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary umbilical endometriosis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. 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Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1438.2006.00199.x" "Revista" => array:6 [ "tituloSerie" => "Int J Gynecol Cancer" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "432" "paginaFinal" => "435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16445672" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/0210573X/0000005100000001/v1_202401240434/S0210573X23000977/v1_202401240434/en/main.assets" "Apartado" => array:4 [ "identificador" => "15132" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Caso Clínico" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0210573X/0000005100000001/v1_202401240434/S0210573X23000977/v1_202401240434/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X23000977?idApp=UINPBA00004N" ]
