Endometrial Osseous Metaplasia-A Rare Cause of Infertility with Unknown Etiology.

Background: Osseous tissue in the endometrium is a rare find, and it is most often discovered when the patient presents with infertility. It is frequently associated with dysmenorrhea and abnormal menstrual bleedings. Although its etiology remains unclear, in almost all described cases until now, the patient has an obstetrical history. Case report: In this report, we present a unique case of endometrial osseous metaplasia in a 27-year-old primary infertile patient. The transvaginal ultrasound revealed a 18/13/7 mm hyperechoic endometrial mass with posterior acoustic shadowing and no flow on color Doppler. A hysteroscopic examination found a polygonal calcification on the endometrial posterior face of the uterine cavity, in the corporeal isthmic region, which was extracted. The histopathological evaluation revealed microscopic elements compatible with endometrial calcification. The patient had a good postoperative course and the complex endocrinologic, immunologic and electrolytical investigation failed to prove any abnormality. Follow-up transvaginal ultrasound examinations revealed no modifications. Three years later, the patient conceived spontaneously, had an uneventful pregnancy and delivered a full-term fetus. Conclusion: We assumed that this entity can be a serious cause of infertility since the patient had a long history of (primary) infertility and its resection made the pregnancy's occurrence possible. Finally, since neither history of abortion or chronic inflammation nor any abnormal laboratory test were noticed, we concluded that the etiology of this entity remained unclear.

Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia.

Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1/0; p < 0.05), reaching its minimum during day 2 (day 2/1; p > 0.05), revealing a significant recovery to day 4 (day 4/2; p < 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI's decrease (during day 1) and the CPR's increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a "positive" effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral "full" vasodilation in the prAEDF group. Furthermore, the CPR's nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.

Cabergoline Failure and a Spontaneous Pregnancy in a Microprolactinoma with High Prolactin Levels.

We report a particular case of a spontaneously occurring pregnancy in a long-term amenorrheic patient due to a prolactinoma with high serum prolactin (PRL) following the failure of dopamine agonist therapy (DA) for infertility. Initially, clinical, laboratory, and genital ultrasounds were normal, but the serum PRL was 10,074 µIU/mL (n.v.: 127−637 µIU/mL), the PEG fraction was 71% (laboratory cut-off > 60%), and luteinizing hormone (LH) was significantly lower. An MRI revealed a pituitary tumor of 12.8/10 mm with a subacute intratumoral hemorrhage. DA was initiated, and menstrual bleeding reappeared with a reduction in the tumor's volume to 1.9/2.2 mm at 12 months. Two years later, the patient renounced DA and follow-ups. After another 2 years, she became spontaneously pregnant. Serum PRL was 18,325 µIU/mL, and an MRI revealed a microprolactinoma of 2.1/2 mm. The patient gave birth to a normal baby at term, and she breastfed for six months, after which she asked for ablactation, and DA was administered. This case highlights the possibility of the occurrence of a normal pregnancy during a long period of amenorrhea induced by a microprolactinoma with a high level of serum PRL, even if DA fails to correct infertility. There was no compulsory relationship between the tumoral volume's evolution and the evolution of its lactophore activity. The hypogonadotrophic hypogonadism induced by high PRL was mainly manifested by low LH, and in this situation, normal levels of FSH and estradiol do not always induce follicle recruitment and development without abnormalities in the ovary ultrasound.

Safety of Electrotherapy Treatment in Patients with Knee Osteoarthritis and Cardiac Diseases.

OBJECTIVE: To assess the safety of electrotherapy applied in the knee area in patients with known atrial arrhythmias or ischemic heart disease, as it is not known whether this treatment induces or aggravates arrhythmias during or immediately after therapy. MATERIAL AND METHODS: The analytical and transversal study involved 46 patients with degenerative knee osteoarthritis (OA), with or without cardiac diseases, from the Clinical Rehabilitation Hospital inpatient center, Cluj-Napoca, Romania. All patients underwent a 10-day physical therapy program for knee OA (electrotherapy, massage and kinesiotherapy). Heart rate and the total number of ventricular and supraventricular extrasystoles were evaluated before and after treatment, by 24 h Holter ECG monitoring. RESULTS: There was no significant increase in heart rate or in the number of ventricular or supraventricular extrasystoles before or after electrotherapy treatment, regardless of the positive or negative history of arrhythmia or ischemic heart disease (all p > 0.05). Mean values during day 1 were: 35.15 (95% CI [9.60−60.75]) for ventricular ones extrasystoles and 91.7 (95% CI [51.69−131.7]) for supraventricular ones, which during day 2 were 38.09 (95% CI [3.68−72.50]), 110.48 (95% CI [48.59−172.36]), respectively. CONCLUSION: One of the most important things to consider when dealing with an OA patient is that they are most likely older than 65 years, which increases the chance of having a cardiac disease. This raises the need for viable interventions regarding the management of this disease in patients that probably have multiple comorbidities, and where pharmacological and surgical management are not possible, limited or have multiple side effects. Electrotherapy used for treating knee OA did not cause a significant increase in heart rate or number of ventricular and supraventricular extrasystoles in this category of patients.

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome.

BACKGROUND: Absent end-diastolic flow (AEDF) in the umbilical artery (UA) worsens the already poor prognosis of growth-restricted fetuses (GRFs) in pregnancies complicated by early-onset preeclampsia with severe features (ESP). METHOD: We assessed the correlation between the effect of maternal dexamethasone (Dex) on AEDF in the UA and perinatal outcomes, in 59 GRFs from EPS-complicated pregnancies. The maternal outcome was also evaluated. RESULTS: The mean maternal age at inclusion was 22.4 ± 5.9 years. Dex transiently restored EDF in the UA in 38 (64.4%) cases (trAEDF group), but in 21 (35.6%) patients, the flow was persistently absent (prAEDF group). The effect lasted up to the 4th day.The gestational age at diagnosis, number of days from admission until delivery, and fetal weight were significantly lower in the prAEDF group than in the trAEDF group (p < .05). The same group had a significantly increased rate of fetal proximal deterioration, low APGAR scores, neonatal hypoxia, assisted ventilation, mild intraventricular haemorrhage (I/II), and respiratory distress syndrome, as well as maternal deterioration, especially in cases of resistant hypertension (p < .05). Although the rates of fetal acidemia and perinatal mortality in the prAEDF group were respectively three times and two times higher, the differences were not significant (p > .05). CONCLUSIONS: The Dex no-effect on UA Doppler in GRFs with AEDF in the UA, in EPS-complicated pregnancies, can be a useful marker for a higher risk of proximal fetal deterioration, poor state at delivery, neonatal hypoxic complications, and worsening maternal condition, but not for perinatal mortality. The findings also highlight the alarmingly younger age of patients with EPS. Finally, all these pregnancies should be monitored in a complex multidisciplinary manner in tertiary referral units.Key messageThe effect of dexamethasone on absent end-diastolic flow in the umbilical artery in growth-restricted fetuses from pregnancies complicated by early-onset preeclampsia with severe features can be a useful prognostic factor for perinatal outcomes.

Is there a relationship in-between ovarian endometriosis and ovarian cancer? Immunohistochemical profile of four cases with coexisting ovarian endometriosis and cancer.

Endometriosis (EMs) is a benign disease characterized by the presence of endometrial tissue outside the uterine cavity. EMs associated with ovarian cancer (OC) has a relative low incidence (5% to 10%), sometimes with evidence of a transition stage through atypical EMs (1.6% cases). We have assessed 135 consecutive patients with either EMs or OC and, out of them, our study reports on four cases of ovarian EMs and OC: two cases with endometrioid OC and two cases with high-grade serous OC (HGSOC). Cases with EMs and HGSOC are extremely rarely reported in the literature - we could find not more than 30 cases. The main objective of our research was to observe the possible similarities between EMs and OC. Secondly, we analyzed the differences between EMs associated with endometrioid OC and EMs associated with HGSOC. We evaluated them in terms of clinical status (age, stages of EMs and OC) and immunohistochemical (IHC) expression of estrogen receptor (ER), progesterone receptor (PR), Ki67, p53, p16, Wilms' tumor 1 (WT1), cluster of differentiation (CD) 34 and CD10 immunomarkers - we could not find in the literature all these markers assessed, in the same time, to such samples. Our results indicated that there are no similarities between EMs and OC and no atypical EMs was identified in our cases. We recorded higher values of ER expression in EMs associated with HGSOC than in EMs associated with endometrioid OC. Higher values of ER expression were also recorded in OC than in endometriotic foci. There were no differences in proliferative rate of endometriotic foci associated with endometrioid OC, compared to EMs associated with HGSOC. An aberrant IHC expression for p53 protein and p16 protein was noted only in HGSOC. Also, a positive immunostaining for Wilms' tumor 1 (WT1) was identified only in HGSOC. Higher values of microvessel density were recorded in OC but not in endometriotic foci. We concluded that there were no similarities between EMs and OC for the cases included in our study, but we noticed differences in terms of Ki67 index and also between hormonal receptors expression in EMs associated with HGSOC, comparing with EMs associated with endometrioid OCs. These results may represent a "brick" for future researches on the less understood EMs associated with type II of OCs, especially with HGSOC. Identifying the best marker, which can predict the risk of developing OC for the patients with EMs, may lead to discover new specific therapeutic agents and, therefore, a better, tailored, therapy.

A unique case of recurrent fetal cystic hygroma: first fetus with an inherited heteromorphism of chromosome 1 (1qh+) and the second fetus with 69XXX triploidy.

The authors report a unique recurrent septated cystic hygroma (CH), on two successive pregnancies, at five years interval. The chromosome analysis of the first fetus showed an increase in length of heterochromatin on the long arm of chromosome 1 - 1qh+, a chromosomal polymorphism inherited from mother, 46XX,1qh+,14ps+,21ps+. The karyotype of the second CH, with more severe ultrasound (US) imaging, showed a 69XXX triploidy. The patient took no risk and underwent each time a termination of pregnancy (TOP). The first karyotype is generally considered "normal", although there are few reports linking 1qh+ with low fertility, but this was not the case, the patient having, from a previous marriage, a healthy boy and two TOPs. So, this "particular", but "healthy" karyotype was not a cause for the first CH. The second karyotype highlights a possible causality between the 69XXX triploidy, usually associated with partial hydatidiform mole, and a more severe septated CH in the last fetus. Neither the CHs' appearance nor their recurrence seemed to be family linked, as the two CHs had distinct genetic profiles. We recommend that, once CH is diagnosed, a careful US examination is compulsory for the determination of subcutaneous edema, ascites, pleural and pericardial effusions and cardiac or renal abnormalities; an early genetic work-up is mandatory, by chorionic villus sampling or amniocentesis. However, a "healthy" karyotype does not exclude a severe form, as in our first case of CH. Due to the very poor outcome of fetuses with CH, the patient must be thoroughly informed about the short and the long-term fetal prognosis.

Giant abdominal tumor - would you think adrenal?

Adrenal cavernomas are rare benign tumors, and those of giant dimensions are exceptional. Usually, they are symptomless or they induce symptoms and signs due to compression over nearby organs. We present the case of a 68-year-old woman, who complained of abdominal enlargement and abdominal pain in the left part of the abdomen. Imagistic investigations (native and contrast abdominal computed tomography) revealed an inhomogeneous retroperitoneal mass of 210∕182∕200 mm, containing calcifications. Laboratory findings were not relevant, just a slight and non-significant elevation of carcinoembryonic antigen and a slight elevation of C-reactive protein. Diagnosis of cancer of undetermined origin was considered, and surgery was performed. During surgery, a giant encapsulated inhomogeneous tumor of 330 mm, with cystic areas, was removed, without assessing the origin. Primary or secondary tumors (metastasis from breast, intestinal, lung, renal or skin cancer) were taken into account. Only histopathology and immunohistochemistry revealed the diagnosis of adrenal cavernoma. Until this moment, we found only one published article in the medical literature with similar dimensions of an adrenal cavernoma as in our case. Even if rare, hemangioma of the adrenal gland must be considered during the differential diagnosis of an adrenal tumor.

Nodular subcutaneous lesion - an alarming sign for an upcoming pancreatic disorder.

Pancreatic panniculitis represents a rare dermatological manifestation mainly due to a pancreatic disorder, but other etiologies are possible. Even rarer, it can occur prior to the clinical signs of the underlying disease, and its presence must orientate the investigations especially towards pancreas, liver and neuroendocrine system. We report a rare case of a 47-year-old male patient who presented to the Emergency Unit complaining about a two weeks-long-persistent pain in the upper abdomen and biliary vomiting. The medical history included alcohol abuse. Several days prior to the onset of these symptoms, the patient has noticed the occurrence of a nodular inflammatory lesion of 5∕3 cm on the right calf (this makes the case even rarer). Based on clinical aspect and high levels of pancreatic enzymes, acute pancreatitis was diagnosed. Contrast-enhanced abdominal computed tomography (CT) revealed a cystic pancreatic mass and dilated intrahepatic biliary ducts. Abdominal magnetic resonance imaging (MRI) revealed a cystic tumor of the pancreatic head and thrombosis of the portal vein, which increased the suspicion of pancreatic adenocarcinoma. Biopsy was performed from the calf nodular lesion, with the diagnosis of panniculitis. This case, besides its rarity, supports the clinical important value of a pancreatic workup in case of histologically proved panniculitis, even without pancreatic related symptoms.

Ovarian teratomas in a patient with Bardet-Biedl syndrome, a rare association.

Bardet-Biedl syndrome (BBS) represents a rare ciliopathy recessive autosomal inherited. The main clinical features are retinal dystrophy, postaxial polydactyly, obesity, different degrees of cognitive deficit, renal impairment, hypogonadism and genital malformations. The genetic explanation consists in BBS genes mutations, which encode modified proteins, altering the function of the immotile cilia. As a multitude of BBS genes mutations were described, the phenotypic aspect of these disorders varies according to that. We present the case of a 22 years old female patient, known with BBS since the age of 11 and which was diagnosed and operated for bilateral ovarian dermoid cysts, at the age of 21. We did not find a similar case in literature, regarding the association between the two disorders. We consider that our case points towards the importance of periodic imagistic evaluations [magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound] of these patients, not only clinical and biological. Usually, the moment they are diagnosed with hypogonadism or genital malformations (in childhood or adolescence), the genital evaluation is neglected thereafter. We also consider that our therapeutic approach can be helpful in other similar clinical situations. Another important conclusion is represented by the importance of genetic counseling of the relatives of a BBS patient, unfortunately insufficiently provided in our region.

Anencephaly: pitfalls in pregnancy outcome and relevance of the prenatal exam.

Anencephaly is an embryological malformation of the central nervous system, invariable lethal, characterized by the absence of the brain and cranial vault and by other defects of the cranial structures. It has no cure but it can be detected during the pregnancy with ultrasonography. We present a rare case of a 15-year-old primipara, with no prenatal care, who delivered at 37 weeks an anencephalous female newborn. Ultrasonography avoided the confusion with a breach presentation, which, in conjunction with the prematurity, premature rupture of membranes and the young maternal age would have favored the cesarean section. The rarity of the case is increased by the singularity of the malformation. The importance of the prenatal care and genetic workup are stressed out in this embryologic pathology.

The variation of serum cortisol during ovarian stimulation for in vitro fertilization.

AIM: As there is no consensus concerning the variation of serum cortisol level during in vitro fertilization (IVF), we studied it prospectively by frequent evaluation throughout the course of an IVF cycle and compared the value, as control, of cortisol concentration obtained in the previous month (M-1) with the concentration obtained on the first day (D1) of ovarian stimulation. METHODS: In 23 IVF cycles using gonadotropin-releasing hormone agonist/human menopausal gonadotropins (hMG)/human chorionic gonadotropin, cortisol and estradiol were measured at M-1, D1, day 14 (D14, before beginning hMG), day 16 (D16), day 19 (D19), day 22 (D22), day 24 (D24), the day before (T-1) and the day after triggering ovulation (T+1), the day of oocyte retrieval (OR), 15 days after embryo transfer (ET+15) and the next month (M2). Statistical analysis used tests of linear tendency, the Pearson chi(2) test, analysis of variance, Student's t test and Spearman correlation. RESULTS: Cortisol was non-significantly lower at M-1 compared with D1; although remaining in the normal range, mean cortisol increased progressively after D1, in a manner unrelated to estradiol, with non-significant differences between different time points but a significant linear tendency and a maximum value at T+1. All mean cortisol values were significantly higher than that at M-1 and, except for D19 and T-1, D1. Mean cortisol decreased at ET+15 and significantly at M2, the value at M2 being lower than that at M-1. CONCLUSION: Cortisol showed a progressive increase beginning from D1, especially after ovulation triggering, and returned to pre-treatment level next month. Cortisol variation was not related to the changes in the E(2) values. Cortisol values at both M-1 and D1 could be used as controls.

[Urachal cyst in an adult woman]. / Chist voluminos de uraca la o femeie adulta.

Urachal abnormalities represent a rare pathology and, in case of presence, they are more frequent in children and, among adults, in men. We report a case of urachal cyst in an adult woman in whom it was difficult to determine preoperatively the origin of the abdominal tumor. Positive diagnosis and treatment implied surgical exploration and resection. Even rare, this pathology should be considered in the differential diagnosis of an abdominal cyst. While the diagnosis may be established by clinical examination and imaging methods, surgical exploration is justified and, besides, offers the therapeutic opportunity.

Preemption dimensional study for obtaining statistically significant results for the variation of gamma-glutamyl-transferase during ovarian stimulation.

BACKGROUND: Ovarian stimulation with gonadotropins/ gonadotropin releasing factor agonists (a-GnRH), largely used currently for infertility treatment, can induce hepatic effects, demonstrated only in animals or in women with hyperstimulation syndrome. AIM: We wanted to estimate the number of included patients for which the variation of gamma-glutamyl-transferase (GGT) during and due to ovarian stimulation could be sustained by statistic validation. METHOD: In 23 consecutive patients, aged 23-45 years (mean 32.6 +/- 7.4 years) included in a fertility program, busereline, an a-GnRH was started the first day of the cycle and followed from the 14th ay with human menopausal gonadotropin. Ovulation was triggered with human chorionic gonadotropin. GGT was measured in the serum the first day (control), in the 14th, 19th, 24th day, the day before the triggering of the ovulation and two days after that. The statistic study used a distribution analysis (Student t test)--BMDP, SAS 6.0 and EpiInfo 5 software and calculated the necessary number of measurements in order to obtain significant (95%) variation for GGT (actual and = 5%). RESULTS AND CONCLUSIONS: The proper number of determinations which statistically support a possible significant difference is 29-38 and 46 for a 5% difference. The considered suppositions are able to support a correct estimation.

Pre-emption dimensional study aiming to obtain significant statistical results for the variation of serum cortisol during ovarian stimulation.

UNLABELLED: Ovarian stimulation has an important place in the contemporary impressive development of infertility treatment. There are few and not concordant data concerning its influence on cortisol serum levels. AIM: The present study aimed at finding the necessary number of determinations in order to statistically assess the variation of cortisol during and caused by the ovarian stimulation. METHODS: In 25 consecutive infertile women (23-45 years old, average: 32.4 years) enrolled in an ovarian stimulation program (gonadotropin releasing hormone agonist--busereline--from the first day of the cycle, human menopausal gonadotropin beginning with the 14th day of the cycle, ovulation triggering by human chorionic gonadotropin), serum cortisol was measured one month before the study, the 1st, 14th, 16th, 19th, 22nd, 24th day, the day before the triggering of the ovulation, one, two, 19 days and one month after triggering. General methods of data analysis map into descriptive and inferential statistics were used, with BMDP, SAS 6.0 and Epilnfo 5 software. RESULTS AND CONCLUSIONS: The calculated number of determinations, in order to obtain a significant statistical variation of cortisol for the studied set of samples and stimulation protocol is between 28-35--but smaller (15 and 19) around ovulation triggering and 39 patients for a > or = 5% variation compared to control values. The suppositions considered in the present paper seem to offer a correct estimation for obtaining the size of the sample sets to be analyzed in a future study.

[Ovarian cyst and pregnancy. Conservative management and consecutive emergency cystectomy. Case report]. / Chist ovarian asociat cu sarcina. Conduita conservativa si chistectomie intempestiva ulterioara. Caz clinic.

The association of an ovarian cyst with pregnancy is relatively rare; it may result in serious maternal and fetal complications and its treatment is still controversial. We present a case in which the rarity is given by the association of an 11cm--serous right ovarian cyst (with signs of torsion) with a monofetal 6 gestation week--pregnancy, by the initial conservative management and by the subsequent laparotomy and cystectomy at 16 gestational weeks, required by the acute abdominal pain caused by the torted cyst. The approach was initially conservative followed by laparotomy and cystectomy at 16 gestation weeks, required by the acute abdominal pain caused by the torsive cyst. Pregnancy was, afterwards, uneventful and the patient delivered vaginally, at term, a 3200 g healthy girl. Management options of such a case are discussed.

[The value of transvaginal ultrasonography in the follow-up of postmenopausal women's endometrium]. / Valoarea ecografiei transvaginale în monitorizarea endometrului pacientelor în postmenopauza.

Endometrial cancer remains, today, a serious problem, especially for postmenopausal women. The aim of our study was to evaluate the utility of the transvaginal ultrasound examination in the management of the endometrial abnormalities in postmenopausal women. We included, in a prospective cohort, 49 successive postmenopausal women: 34 with metrorrhagia (group I) and 15 with no symptoms (group II) and we compared the results obtained by ultrasound examination, Pap smear and endometrial biopsy. Patients in group I had a higher frequency of risk factors and thick and abnormal endometrium. Unlike Pap smear, ultrasound examination and biopsy had comparable values. We could conclude that transvaginal sonography is a reliable technique for the endometrium evaluation in the postmenopausal women. Ultrasound exam could select the cases (without any symptoms) for endometrial biopsy and detect associated gynecological pathology.

[Etiologic, clinical and prognostic correlations in abruptio placentae]. / Dezlipirea prematura de placenta normal inserata. Corelatii etiologice, clinice si prognostice.

Placental abruption implies, still, a largely unknown causality and frequent unsatisfactory results. This study was designed to explore the possible correlations between some etiologic factors, the dependent clinical decisions and outcome. In a prospective cohort, we included 95 successive pregnant women (aged 15-42, 22-42 gestational weeks) with abruptio placentae necessitating cesarean section, during 2001-2005. Maternal blood pressure, premature rupture of membranes, infants' sex ratio, hematomas' volumes were correlated with the clinical outcome. There were 25 mortality cases (2 maternal and 23 fetal) and physicians performed 9 hysterectomies (2 with bilateral adnexectomy). Premature rupture of membranes was seen in 32% of the cases. Hypertension was an etiological and aggravating factor: it was reported in 70% of cases, in all the severe ones. The volume of placental hematomas was in direct concordance with the severity of the outcome. Interestingly, the majority of the patients were young and 63% of newborns were male.

Asymptomatic abdominal wall endometrioma 15 years after cesarean section.

Abdominal wall endometriosis is rare and its diagnosis is difficult. However, the consequences may be serious, like recurrences or even malignant transformation. We report a rarer case of asymptomatic abdominal wall endometrioma, accidentally found during a surgical procedure for a second cesarean section, in a 39-years old patient, without any relevant history of endometriosis. The tumor was subcutaneous, 3/3 cm in size, located in the left angle of the incision from the 15 years previously performed cesarean section and freely mobile in relation with the skin and the fascia. It was excised, with clear margins (to prevent recurrences), during the procedure. The patient was discharged after five days. The postoperative period and the follow-up at one and three months were uneventful. The pathological examination clarified the diagnosis by revealing an endometrioma with decidual reaction. Such a condition may be, therefore, evoked before an abdominal wall tumor, even without specific symptoms, even in a 39-years old woman and longtime after the possible causal surgery. Pathological examination remains the ultimate diagnostic tool. Relevant prophylactic attitude at the end of the cesarean section may be considered.