Endgames Case report

An umbilical nodule with cyclical changes

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5855 (Published 22 September 2011) Cite this as: BMJ 2011;343:d5855
  1. Matthias Möhrenschlager, dermatologist1,
  2. Helmut P Arbogast, surgeon2,
  3. Verena Henkel, psychiatrist3
  1. 1Department of Dermatology and Allergology, Hochgebirgsklinik, Davos, Switzerland
  2. 2Department of Surgery, Grosshadern Medical Centre, Ludwig-Maximilians-Universität, Munich, Germany
  3. 3Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
  1. Corresponding to: M Möhrenschlager matthias.moehrenschlager{at}hgk.ch

A 47 year old non-parous woman who had never had abdominal surgery was admitted with a four year history of an intermittently palpable nodule in the umbilical region. Initially, she noticed an increase in lesional size and pressure pain, which resolved within a few days. Six months before admission, blue-black discoloration appeared in the umbilical area; this vanished within a week but reappeared cyclically, along with an increase in size of the nodule and localised discomfort.

Macroscopic inspection during menstruation showed a sharply confined blue-black macule within the umbilical area. Lesional palpation identified a circumscribed, firm, well relocatable pea sized nodule just below the umbilical skin. Dermoscopy of the area showed features corresponding to a cutaneous haematoma.

Questions

  • 1 What is the likely diagnosis?

  • 2 Which differential diagnoses have to be considered?

  • 3 Which diagnostic procedure(s) would be appropriate?

  • 4 What kind of treatment would you recommend?

Answers

1 What is the likely diagnosis?

Short answer

Umbilical endometriosis.

Long answer

Figure 1 shows the umbilical area with a discrete central blue-black macule. The occurrence of this visible and …

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