PMC6930385_01
Intraoperative images: (a) left pelvic cyst (a 4 cm ovarian remnant cyst) was identified and the entire ovary was removed; (b) endometriotic nodules and endometriosis on left external iliac artery and vein.
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A 4 cm ovarian remnant was identified and the entire ovary was removed (Figure 1(a)).
Intraoperative images: (a) adhesion of bowel and omentum to anterior abdominal wall; (b) white patches of endometriotic implants; (c) endometriotic implants on the large bowel (left), adhesions of omentum to large bowel (right).
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Bowel endometriosis was resected with the TA stapler though the 5 cm umbilical incision (Figure 2(c)).
Pathology slides: left external iliac nodule biopsy: (a) endometrial-type stroma (long black arrow) and capillary (short black arrow) with hemosiderin-laden macrophage (white arrow). (H&E stain); (b) endometrial-type stroma is positive for CD10 (CD10 immunohistochemical stain).
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The final pathology report (Figures 3(a) and 3(b)) confirmed evidence of burnt-out endometriosis in all locations including bowel and external iliac nodule. In the left external iliac vessel, residual endometrial-type stroma, vasculature, and hemosiderotic macrophages were seen on H&E stain (Figure 3(a)), and highlighted by CD10 immunohistochemical stain (Figure 3(b)).