A 38-Year-Old Woman With Debilitating Premenstrual Pain

Linda A. Dultz, MD, MPH; Karina L. Vivar; Suzanne MacFarland; MaryAnn Hopkins, MD, MPhil

Disclosures

July 26, 2019

Physical Examination and Workup

Upon initial examination, her temperature is 97.6°F (36.4°C), blood pressure is 126/83 mm Hg, heart rate is 67 beats/min, respiratory rate is 12 breaths/min, and oxygen saturation is 99% on room air. She has a firm, nonmobile, nonpulsatile, ill-defined, tender mass palpated to the left of her umbilicus. The mass is remote from her prior surgical incisions. The remainder of her examination, including the pelvic examination, is unremarkable.

The preoperative laboratory findings are within normal limits. An MRI demonstrates a 3.2 × 2.4 × 1.8 cm mass within the left abdominal rectus muscle, which deforms the posterior rectus fascia. The radiologic features are interpreted as being most compatible with abdominal wall fibromatosis. The patient is offered surgical excision. Intraoperatively, the mass is excised from within the musculature of the rectus without disturbing the posterior rectus fascia. Grossly, the mass is found to be 3.7 × 3.3 × 1.4 cm and composed of tan-yellow, soft, lobular, fibrous adipose tissue. Histologic sections are shown (Figures 1 and 2).

Figure 1.

Figure 2.

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