Differential diagnoses of an inguinal mass in women include inguinal hernia, femoral hernia, a lymph node, lipoma and hydrocele of the canal of Nuck. Symptoms of extrapelvic endometriosis, often diverse and puzzling, usually result from functioning endometrial tissue or scarring at the affected site. The location of the endometriosis, not the size of the implant, determines the symptoms. Many women with extensive endometriosis are asymptomatic, yet a small focus of disease in a particular location can produce disturbing problems. 3 Clues to the presence of endometriosis include pain, bleeding or organ dysfunction related to menstruation.
Noncyclical symptoms can confuse the clinician.
It has been proposed that these extragenital lesions, especially those further away from the uterus, tend to lose their hormonal receptors and response, hence the lack of cyclical symptoms. 4 Ultrasonography has been used to aid in the diagnosis of endometrioma, which can occur as a cystic-solid lesion. The treatment is surgical excision of the mass. Local recurrence at the surgical scar has been reported. 6 Patients should undergo a full gynecologic assessment to search for pelvic endometriosis.