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Guo S, Liu C, Lin Y, Zhu J, Wang Z, Wang Z. Submucosal cystic adenomyosis: a report of five cases and review of the literature. BMC Womens Health 2024; 24:493. [PMID: 39237926 PMCID: PMC11375844 DOI: 10.1186/s12905-024-03332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024] Open
Abstract
AIM To investigate the clinical characteristics, diagnosis, and clinical treatment of submucosal cystic adenomyosis. METHODS The clinical data of five cases of patients with submucosal cystic adenomyosis in our hospital from January 2020 to June 2023 were retrospectively analyzed. RESULTS The average age of the patients was 37.8 ± 4.5 years old, three of them experienced prolonged menstruation and heavy menstrual bleeding. All patients had a history of abnormal uterine bleeding and mild to moderate dysmenorrhea, with a VAS score of 2.8 ± 1.6. The average Carbohydrate antigen 125 (CA125) value was 29.9 ± 23.6U/ml. Two out of the five patients (40%) had CA125 values above the upper limit of normal. The nodules had a diameter of 3.2 ± 1.3 cm and a cavity size of 1.3 ± 0.7 cm. Color ultrasound revealed hypo or iso or anechoic echoic cysts, and blood flow signals were detected. The magnetic resonance imaging (MRI) findings varied among each patient. All the patients underwent hysteroscopy and resection of uterine cavity-occupying lesions, and no recurrence was observed. CONCLUSIONS The clinical features of submucosal cystic adenomyosis include abnormal uterine bleeding and menstrual changes, and the degree of dysmenorrhea is generally not severe. The diagnostic utility of CA125 in submucosal cystic adenomyosis may be limited. The three-dimensional ultrasound and MRI are valuable preoperative examination methods currently. Hysteroscopy can not only diagnose submucosal cystic adenomyosis, but also treat it, and preserve the fertility function of the patient.
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Affiliation(s)
- Sang Guo
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China
| | - Chaobin Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China
| | - Yan Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China
| | - JianFang Zhu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China
| | - Zhenna Wang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China.
| | - Zhenhong Wang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18, Daoshan Rd., Gulou Dist, Fuzhou City, Fujian Province, China.
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Strug M, Christmas A, Schoonover A, Romero VC, Cordoba M, Leary E, Thakur M. Impact of an accessory cavitated uterine mass on fertility: case presentation and review of the literature. F S Rep 2023; 4:402-409. [PMID: 38204942 PMCID: PMC10774890 DOI: 10.1016/j.xfre.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 01/12/2024] Open
Abstract
Objective We report a case of an accessory cavitated uterine mass (ACUM) in a patient with infertility and chronic pelvic pain. In addition, we summarize the literature to better characterize ACUM diagnosis and management. Design A comprehensive literature search using the PubMed database was performed through April 2023. Historical ACUM diagnostic criteria were applied as inclusion criteria. Descriptive statistics and statistical evaluation were reported. Results A 31-year-old nulligravid woman presented with chronic pelvic pain, dysmenorrhea, primary infertility, and history of endometriosis. Three-dimensional ultrasonography identified an ACUM and laparoscopic excision provided complete resolution of symptoms. Subsequently, she conceived without assistance twice with uncomplicated vaginal deliveries. A total of 154 articles were identified, 34 papers met inclusion criteria and were individually reviewed, consisting of 70 reported cases. The most common presenting complaints were dysmenorrhea (81.4%), chronic pelvic/abdominal pain (54.1%), and refractory pain (34.3%). Diagnostic imaging included magnetic resonance imaging (62.9%) and transvaginal ultrasound (55.7%). Management included resection via laparoscopy (75.7%) or laparotomy (18.6%), or hysterectomy (5.7%). Of cases with reported outcomes, 90.7% had complete relief of symptoms after surgery. Conclusion ACUM often presents with dysmenorrhea, chronic pelvic pain, or abdominal pain and is identifiable on magnetic resonance imaging as a hyperenhancing mass. Three-dimensional transvaginal ultrasound can also accurately identify ACUM. A total of 90.7% of patients had complete relief of symptoms after intervention. It is important to identify ACUM early to relieve pain and reduce unnecessary interventions. Like our patient, other reports have demonstrated concomitant infertility and endometriosis. However, further investigation is needed to explore the association between infertility and ACUM.
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Affiliation(s)
- Michael Strug
- Division of Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Abigail Christmas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Amanda Schoonover
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Vivian C. Romero
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Marcos Cordoba
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Elizabeth Leary
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Gynecology, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Mili Thakur
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Gynecology, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
- The Fertility Center, Grand Rapids, Michigan
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Accessory and cavitated uterine mass versus juvenile cystic adenomyoma. F S Rep 2021; 2:357-358. [PMID: 34553164 PMCID: PMC8441564 DOI: 10.1016/j.xfre.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
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Koninckx PR, Fernandes R, Ussia A, Schindler L, Wattiez A, Al-Suwaidi S, Amro B, Al-Maamari B, Hakim Z, Tahlak M. Pathogenesis Based Diagnosis and Treatment of Endometriosis. Front Endocrinol (Lausanne) 2021; 12:745548. [PMID: 34899597 PMCID: PMC8656967 DOI: 10.3389/fendo.2021.745548] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022] Open
Abstract
Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, which thus is different from implanted endometrium. The subsequent growth in the specific environment of the peritoneal cavity is associated with angiogenesis, inflammation, immunologic changes and bleeding in the lesions causing fibrosis. Fibrosis will stop the growth and lesions look burnt out. The pain caused by endometriosis lesions is variable: some lesions are not painful while other lesions cause neuroinflammation at distance up to 28 mm. Diagnosis of endometriosis is made by laparoscopy, following an experience guided clinical decision, based on history, symptoms, clinical exam and imaging. Biochemical markers are not useful. For deep endometriosis, imaging is important before surgery, notwithstanding rather poor predictive values when confidence limits, the prevalence of the disease and the absence of stratification of lesions by size, localization and depth of infiltration, are considered. Surgery of endometriosis is based on recognition and excision. Since the surrounding fibrosis belongs to the body with limited infiltration by endometriosis, a rim of fibrosis can be left without safety margins. For deep endometriosis, this results in a conservative excision eventually with discoid excision or short bowel resections. For cystic ovarian endometriosis superficial destruction, if complete, should be sufficient. Understanding pathophysiology is important for the discussion of early intervention during adolescence. Considering neuroinflammation at distance, the indication to explore large somatic nerves should be reconsidered. Also, medical therapy of endometriosis has to be reconsidered since the variability of lesions results in a variable response, some lesions not requiring estrogens for growth and some being progesterone resistant. If the onset of endometriosis is driven by oxidative stress from retrograde menstruation and the peritoneal microbiome, medical therapy could prevent new lesions and becomes indicated after surgery.
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Affiliation(s)
- Philippe R. Koninckx
- Latifa Hospital, Dubai, United Arab Emirates
- Prof Emeritus Obstet Gynecol (OBGYN), Catholic University Leuven (KU), Leuven, Belgium
- University of Oxford-Hon Consultant, Oxford, United Kingdom
- University Cattolica, Roma, Italy
- Moscow State University, Moscow, Russia
- Gruppo Italo Belga, Villa Del Rosario, Rome, Italy
- *Correspondence: Philippe R. Koninckx,
| | - Rodrigo Fernandes
- Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - Anastasia Ussia
- University Cattolica, Roma, Italy
- Gruppo Italo Belga, Villa Del Rosario, Rome, Italy
| | - Larissa Schindler
- Dubai Fertility Centre of the Dubai Health Authority, Dubai, United Arab Emirates
| | - Arnaud Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
- Prof Department of Obstetrics and Gynaecology, University of Strasbourg, Strasbourg, France
| | | | | | | | | | - Muna Tahlak
- Latifa Hospital, Dubai, United Arab Emirates
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