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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endometriosis is a gynecological condition characterized by glands and&#47;or endometrial stroma located outside the uterine cavity&#59; it affects approximately 10&#37; of women of reproductive age&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It mostly occurs in the pelvic cavity&#44; but can also affect extragenital locations&#44; including the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Umbilical endometriosis accounts for less than 1&#37; of all cases of extragenital endometriosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3</span></a> The umbilicus is the most common site for cutaneous endometriosis &#40;40&#37; of all cases&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 29-year-old nulliparous women&#44; a current smoker&#44; presented with umbilical lesions of 2 years&#8217; duration&#46; The lesions were not painful&#44; but she described cyclic bleeding during menstruation&#46; She denied dysmenorrhea&#44; dyspareunia&#44; and infertility&#44; and there was no history of abdominal surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed several reddish-brown lesions that were nonreducible and painless on palpation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histologic examination of a biopsy specimen showed endometrial glands lined by a pseudostratified cylindrical epithelium and extravasated red blood cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Immunohistochemical staining was positive for CD10&#44; confirming the presence of ectopic endometrial stroma<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Subsequent gynecological evaluation including ultrasound and cervical cytology ruled out genital disease&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient also underwent abdominal magnetic resonance imaging &#40;MRI&#41;&#44; which revealed a well-defined oval skin lesion showing intense contrast uptake in the umbilical region&#46; The lesion was touching but did not invade the underlying abdominal muscles &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; No other foci of endometriosis were observed&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical excision was considered during follow-up&#44; but the patient became pregnant and the surgery was postponed&#46; The lesions remained stable during pregnancy and resolved spontaneously several days after delivery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#8211;D&#41;&#46; No recurrences or new lesions have occurred during 2 years of follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Umbilical endometriosis accounts for between 0&#46;4&#37; and 4&#37; of all endometriosis cases&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Secondary umbilical endometriosis is more common than primary umbilical endometriosis and is associated with surgical scars following abdominal surgery&#46; Patients with the primary form of this disease do not have a prior surgical history&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Umbilical endometriosis usually affects women in their third decade of life and typically presents as an asymptomatic or painful red-violaceous nodule that exhibits cyclic bleeding during menstruation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A tentative diagnosis is usually based on clinical findings and confirmed by histology&#46; Apart from endometrial glands and stroma&#44; histology may also show hemosiderin deposits&#44; inflammatory changes&#44; and marked mitotic activity&#46; Immunostaining with CD10&#44; which is positive in the endometrial interstitium&#44; is useful when glands are not seen on histology&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis should include cutaneous metastases&#44; melanoma&#44; seborrheic keratosis&#44; pyogenic granuloma&#44; and keloids&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Imaging tests such as ultrasound&#44; computed tomography&#44; and MRI are useful for ruling out involvement of other organs and establishing lesion depth&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Surgical excision is the treatment of choice&#46; Hormone therapy can be used in patients with systemic disease or before surgery to try to reduce the size of lesions&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In relation to the effect of pregnancy on umbilical endometriosis&#44; Razzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> published the case of a woman whose lesions resolved spontaneously 2 months after biopsy&#44; at 24 weeks&#8217; gestation&#46; Wiegratz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> by contrast&#44; described a patient with a 2-year history of primary umbilical endometriosis whose nodules enlarged progressively during pregnancy and whose bleeding changed from cyclic to continuous&#46; The woman underwent surgery before the pregnancy reached full term&#46; Our patient&#39;s lesions remained stable during pregnancy&#44; although they protruded more as the belly grew&#46; The bleeding stopped during pregnancy and the lesions resolved spontaneously several days after delivery&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Pregnancy has conventionally been believed to have a beneficial effect on endometriosis&#44; and some patients have even been advised to become pregnant as part of their treatment plan&#46; In a recent review&#44; however&#44; Leeners et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> concluded that there was insufficient evidence to expect pregnancy to reduce the number or size of endometriosis lesions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There is also insufficient evidence to predict the effects of pregnancy on umbilical endometriosis based on the 3 cases described to date&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We have described&#44; to our knowledge&#44; the third case of umbilical endometriosis in a pregnant woman&#46; The patient&#39;s lesions remained stable during pregnancy and resolved spontaneously after birth&#46; More cases are required to determine the effects of pregnancy on umbilical endometriosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letter
Course of Spontaneous Primary Umbilical Endometriosis With Pregnancy
Endometriosis umbilical espontánea primaria. Evolución durante el embarazo
A. López Mateosa,
Autor para correspondencia
analopezmateos92@gmail.com

Corresponding author.
, J.L. Agudo Menab, M.A. Cuenca Sáezc, J.M. Azaña Defeza
a Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
b Servicio de Dermatología, Hospital General de Villarrobledo, Villarrobledo, Albacete, Spain
c Servicio de Dermatología, Hospital Público General de Almansa, Almansa, Albacete, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endometriosis is a gynecological condition characterized by glands and&#47;or endometrial stroma located outside the uterine cavity&#59; it affects approximately 10&#37; of women of reproductive age&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It mostly occurs in the pelvic cavity&#44; but can also affect extragenital locations&#44; including the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Umbilical endometriosis accounts for less than 1&#37; of all cases of extragenital endometriosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3</span></a> The umbilicus is the most common site for cutaneous endometriosis &#40;40&#37; of all cases&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 29-year-old nulliparous women&#44; a current smoker&#44; presented with umbilical lesions of 2 years&#8217; duration&#46; The lesions were not painful&#44; but she described cyclic bleeding during menstruation&#46; She denied dysmenorrhea&#44; dyspareunia&#44; and infertility&#44; and there was no history of abdominal surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed several reddish-brown lesions that were nonreducible and painless on palpation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histologic examination of a biopsy specimen showed endometrial glands lined by a pseudostratified cylindrical epithelium and extravasated red blood cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Immunohistochemical staining was positive for CD10&#44; confirming the presence of ectopic endometrial stroma<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Subsequent gynecological evaluation including ultrasound and cervical cytology ruled out genital disease&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient also underwent abdominal magnetic resonance imaging &#40;MRI&#41;&#44; which revealed a well-defined oval skin lesion showing intense contrast uptake in the umbilical region&#46; The lesion was touching but did not invade the underlying abdominal muscles &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; No other foci of endometriosis were observed&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical excision was considered during follow-up&#44; but the patient became pregnant and the surgery was postponed&#46; The lesions remained stable during pregnancy and resolved spontaneously several days after delivery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#8211;D&#41;&#46; No recurrences or new lesions have occurred during 2 years of follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Umbilical endometriosis accounts for between 0&#46;4&#37; and 4&#37; of all endometriosis cases&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Secondary umbilical endometriosis is more common than primary umbilical endometriosis and is associated with surgical scars following abdominal surgery&#46; Patients with the primary form of this disease do not have a prior surgical history&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Umbilical endometriosis usually affects women in their third decade of life and typically presents as an asymptomatic or painful red-violaceous nodule that exhibits cyclic bleeding during menstruation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A tentative diagnosis is usually based on clinical findings and confirmed by histology&#46; Apart from endometrial glands and stroma&#44; histology may also show hemosiderin deposits&#44; inflammatory changes&#44; and marked mitotic activity&#46; Immunostaining with CD10&#44; which is positive in the endometrial interstitium&#44; is useful when glands are not seen on histology&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis should include cutaneous metastases&#44; melanoma&#44; seborrheic keratosis&#44; pyogenic granuloma&#44; and keloids&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Imaging tests such as ultrasound&#44; computed tomography&#44; and MRI are useful for ruling out involvement of other organs and establishing lesion depth&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Surgical excision is the treatment of choice&#46; Hormone therapy can be used in patients with systemic disease or before surgery to try to reduce the size of lesions&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In relation to the effect of pregnancy on umbilical endometriosis&#44; Razzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> published the case of a woman whose lesions resolved spontaneously 2 months after biopsy&#44; at 24 weeks&#8217; gestation&#46; Wiegratz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> by contrast&#44; described a patient with a 2-year history of primary umbilical endometriosis whose nodules enlarged progressively during pregnancy and whose bleeding changed from cyclic to continuous&#46; The woman underwent surgery before the pregnancy reached full term&#46; Our patient&#39;s lesions remained stable during pregnancy&#44; although they protruded more as the belly grew&#46; The bleeding stopped during pregnancy and the lesions resolved spontaneously several days after delivery&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Pregnancy has conventionally been believed to have a beneficial effect on endometriosis&#44; and some patients have even been advised to become pregnant as part of their treatment plan&#46; In a recent review&#44; however&#44; Leeners et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> concluded that there was insufficient evidence to expect pregnancy to reduce the number or size of endometriosis lesions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There is also insufficient evidence to predict the effects of pregnancy on umbilical endometriosis based on the 3 cases described to date&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We have described&#44; to our knowledge&#44; the third case of umbilical endometriosis in a pregnant woman&#46; The patient&#39;s lesions remained stable during pregnancy and resolved spontaneously after birth&#46; More cases are required to determine the effects of pregnancy on umbilical endometriosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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