What is your diagnosis?

What is your diagnosis?A 42-year-old woman presented to the outpatient department with a skin-colored, non-tender, firm, immobile subcutaneous lump on the left corner of the Pfannenstiel scar.The patient noticed the mass eight years back.Initially it was pea sized but gradually increased to approximately 15x15 cm.It was associated with dull aching pain that started two days before menses and lasted five days after completion of menses.This period was also associated with cyclical dyspareunia and swelling around the lump.Her obstetric history was notable for a full term, normal vaginal delivery 15 years earlier followed by medical termination of pregnancy 12 years earlier because of a malformed fetus.She underwent full term lower segment cesarean section (LSCS) for antepartum hemorrhage 10 years back.Her previous menstrual cycles were regular with average flow.The patient used homeopathic medication for 6-8 months, but did not experience any relief.She had multiple consultations and hospital visits for the same complaint for the last six years.Fine needle aspiration cytology done six years earlier at another center was suggestive of inflammatory cells, while another performed four years before presentation to our department reported degenerated cells.On abdominal examination, an immobile, non-tender, hard mass of about 15x12 cm was felt above the pubic symphysis with no local rise of temperature.The mass was adherent to the anterior abdominal wall (Figure 1).On per vaginal and per rectal examination, the cervix was firm, regular and pulled anteriorly, the uterus was posterior and adherent to the mass, although bilateral fornices were free.Given the clinical presentation, the differential diagnosis may include hematoma, stitch granuloma, lymphadenopathy, dermatofibroma, keloid mass, neuroma, abscess, desmoid tumor, or scar endometrioma and imaging will provide additional insight for diagnosing the lesion.