# Cutaneous Tattoo Ink as a Mimicker of Endometriosis-Like Lesions on Diagnostic Laparoscopy

## TL;DR

A patient's tattoo ink was mistaken for endometriosis during surgery, highlighting the need for surgeons to recognize this rare but possible mimic.

## Contribution

Identifies cutaneous tattoo ink as a potential mimic of endometriosis during laparoscopy.

## Key findings

- Histopathology showed no endometriosis but found tattoo-like pigment in lymph nodes.
- Tattoo ink migration was suspected to cause lymphadenopathy resembling endometriosis.
- Surgeons should be aware of this phenomenon to avoid misdiagnosis.

## Abstract

This paper presents the case of a 28-year-old with a history of chronic pelvic pain suspicious of endometriosis. She underwent a diagnostic laparoscopy and biopsy of lesions along the posterior cul-de-sac and right sidewall near the external iliac artery. Histopathological examination revealed no evidence of endometriosis but did comment on benign lymph node tissue with tattoo-like pigment. These findings correspond to the patient’s tattoos located along the lower extremities. It is suspected there was cutaneous tattoo ink migration causing intra-abdominal lymphadenopathy, which visually mimicked endometriosis on diagnostic laparoscopy. Surgeons should become familiar with and recognize this phenomenon, as it can be misleading in the setting of endometriosis and diagnostic laparoscopy. Surgeons undertaking these cases must be able to identify and safely excise abnormal-appearing lesions in many different locations to prevent a missed or delayed diagnosis of endometriosis.