The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Villar’s Nodule — Umbilical Endometriosis

A B

A 
37-year-old woman presented with a brownish tumor protruding Chia-Sui Weng, M.D.
from her umbilicus (Panel A), noting that it bled cyclically, in synchroniza- Yuh-Cheng Yang, M.D.
tion with her menstrual period. Her medical history was significant for Mackay Memorial Hospital
dysmenorrhea and two recent laparoscopic resections of endometriomas. Physical Taipei, Taiwan
examination was unremarkable aside from the finding of a fixed, anteroflexed uter-
us and adnexa. Gestrinone, an oral antigonadotropic agent, was administered for
2 months, without improvement. A reconstructed sagittal computed tomographic
image showed that the umbilical mass extended to the peritoneum (Panel B, arrow-
head). The image also revealed a pelvic cyst with a diameter of 5 cm and a radio-
logic appearance consistent with another endometrioma (Panel B, arrow). Although
the patient did not want resection of the pelvic cyst, the umbilical tumor was ex-
cised, and histologic examination revealed the presence of endometrial glands and
stroma. Endometriosis of the umbilicus, also called Villar’s nodule, is a rare presen-
tation of extrapelvic endometriosis. It is hypothesized that endometrial tissue occurs
at the umbilicus by means of hematogenous or lymphatic seeding, metaplasia of
urachal remnants, or direct seeding from prior laparoscopic procedures. When seen
at a follow-up visit at 8 months, the patient continued to have mild dysmenorrhea,
but the Villar’s nodule had not recurred.
Copyright © 2011 Massachusetts Medical Society.

n engl j med 364;21  nejm.org  may 26, 2011 e45

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