A Case of Appendiceal Endometriosis occurring 13 years after Hysterectomy with Bilateral Adnexectomy

Yoshiki Sato, Toshihisa Kimura, Toshiyuki Nakazawa, Shinsuke Obata, Kazuo Takeuchi, Akio Yamaguchi¹⁾ and Yoshiaki Imamura²⁾

Department of Surgery of Maizuru Kyosai Hospital
1st Department of Surgery Faculty of Medicine¹⁾ and Division of Surgical Pathology of Medicine²⁾, University of Fukui

We report a case of appendiceal endometriosis occurring over 13 years after hysterectomy with bilateral adnexectomy. A 60-year-old woman who had undergone this hysterectomy for uterine myoma at age 47 was seen in September 2008 for lower right abdominal pain. Abdominal computed tomography indicated possible appendiceal perforation, necessitating emergency surgery, which showed erythematous appendix with a thickened wall. After appendectomy removing the appendix at the root, histopathological examination showed an atrophic appendix with mucosal epithelial loss. The resected appendix wall evidenced chronic inflammation and endometrial tissue, with enlarged glandular cavities and endometrial stroma. Immunohistochemistry of endometrial tissue showed positive staining for the estrogen receptor and weakly positive staining for the progesterone receptor, yielding a final diagnosis of appendiceal endometriosis. Appendiceal endometriosis occurs predominantly in reproductive-age women and is rarely reported in those postmenopausal. No reports have been published, to our knowledge, of appendiceal endometriosis occurring over a decade after hysterectomy with bilateral adnexectomy, making ours an interesting case worth reporting.

Key words
appendiceal endometriosis, after hysterectomy

Reprint requests
Yoshiki Sato Department of Surgery of Maizuru Kyosai Hospital
1035 Aza Hama, Maizuru, 625-8585 JAPAN

Accepted
April 28, 2010

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