Left isolated inguinal endometriosis without pelvic endometriosis associated with PCOS and review of literature

The coexistence of polycystic ovary syndrome (PCOS) and endometriosis is rare. Inguinal endometriosis (IEM) is an uncommon extrapelvic form of endometriosis, accounting for approximately 0.3-0.6% of all cases. It typically presents as inguinal swelling with cyclical pain and enlargement related to the menstrual cycle. A 40-year-old woman with a known diagnosis of type 1 PCOS and a history of two cesarean sections presented with a painful mass in the left inguinal region. The pain and swelling were cyclical in nature and became more pronounced during menstruation. The patient reported that her symptoms had worsened following the discontinuation of combined oral contraceptives, which she had been using for PCOS management. Physical examination revealed a tender mass in the left groin. Ultrasonography and magnetic resonance imaging demonstrated a lesion in the left inguinal region suggestive of endometriosis. Based on clinical and radiological findings, surgical intervention was planned. The patient underwent laparotomy, during which the left round ligament and the associated mass were completely excised. Intraoperative findings were consistent with endometriosis. The postoperative course was uneventful. Histopathological examination of the excised tissue confirmed the diagnosis of endometriosis. PCOS can be associated with inguinal endometriosis even without pelvic endometriosis.