Rare case of giant cystic adenomyoma mimicking a uterine malformation, diagnosed and treated by hysteroscopy

Cystic adenomyoma of the uterus: Case report and literature review

Cystic adenomyosis is a rare type of adenomyosis. The main clinical manifestation of uterine cystic adenomyoma is severe dysmenorrhoea, and the condition can be diagnosed by relevant clinical examination. The preferred treatment, with a good prognosis, is lesion resection. The clinical data of a patient with uterine cystic adenomyoma recorded at the Third Hospital of Hebei Medical University are reported herein. A 39-year-old female patient presented with tolerable menstrual pain and aggravated dysmenorrhoea, which she had experienced for 4 years, and menorrhagia, which she had had for approximately 1 year. Ultrasound and tumour marker tests suggested abnormalities, and magnetic resonance imaging confirmed a diagnosis of uterine cystic adenomyoma. A hysteroscopy and intrauterine lesion electrocision were performed, and the results of postoperative pathology tests suggested that the endometriosis cysts had returned to normal after the postoperative intervention. The analysis of the clinical manifestations and diagnosis and treatment of uterine cystic adenomyoma can improve the understanding of the disease and reduce the rates of misdiagnosis and missed diagnoses to ensure early detection with timely diagnosis and treatment.

Accessory and cavitated uterine masses: a case series and review of the literature

Objectives

The purpose of this study is to report nine patients of young women who underwent a surgical treatment of an accessory and cavitated uterine mass (ACUM) in our hospital between 2014 and 2022 and review all cases described in the literature.

Material and methods

The principal outcomes measured are the imaging techniques used to determine the diagnosis, the type of surgery used and the post-operative evolution of symptoms. We also report and analyse the 79 patients found in the literature since 1996 in addition to our 9 patients.

Results

Surgical excision is the only long-lasting treatment. Small invasive surgery with laparoscopic access is the gold standard and most widely used (83.0%). Some new therapeutic procedures have been recently described of which ethanol sclerotherapy seems very promising. Post-operatively, 54.5% of patients have a complete relief of symptoms. MRI is the best imaging technique to identify ACUM. Finally, we refine the description of this pathology and give a more precise definition of it.

Conclusion

Through our literature review and the analysis of our cases, we want to underline an important diagnostic criterion of this pathology: the fallopian tube on the homolateral side of the ACUM never communicates with the latter. It is a capital element for differential diagnosis.

Subserous Cystic Adenomyosis: A Case Report and Review of the Literature

Introduction

Cystic adenomyosis is a rare type of adenomyosis that often occurs in adolescents or women of childbearing age. Due to the few reports of this case, its clinical characteristics have not been clearly established.

Case Presentation

We treated a 32-year-old married patient with cystic adenomyosis that reported persistent abdominal pain and massive vaginal bleeding, so an emergency laparotomy was performed. The intraoperative findings and post-operative pathology proved that the diagnosis was correct. The prognosis of the patient is good, and there is no recurrence within 3 months after surgery.

Results

Surgery is the most effective way to treat cystic adenomyosis. Ultrasound and magnetic resonance are the most effective auxiliary examinations for diagnosing the disease.

Conclusion

Cystic adenomyosis is a sporadic disease. This article summarizes this condition's clinical manifestations, pathological features, diagnosis, treatment, and prognosis by reviewing the existing literature and the case presented in this report. It is noteworthy that early diagnosis and individualized treatment strategies can improve patients' quality of life.

Ultrasound-Guided Transvaginal Aspiration and Sclerotherapy for Uterine Cystic Adenomyosis: Case Report and Literature Review

Background

Uterine cystic adenomyosis is a very rare type of adenomyosis which can be easily misdiagnosed in clinical practice. In the past, cases have been mostly treated with surgical resection of the uterine lesion.

Case Presentation

We report the case of a 25-year-old woman who presented with severe dysmenorrhea for more than 1 year. Physical examination showed that the uterus was enlarged. The transvaginal ultrasound showed a cystic mass of about 5.0 × 3.6 × 3.6 cm in the posterior myometrium, with dense echo spots and no blood flow signal in the cystic part. Magnetic resonance imaging (MRI) indicated hemorrhages within the cystic mass, suggesting the possibility of uterine cystic adenomyosis. The lower abdominal pain and severe dysmenorrhea were not alleviated after a 6-month trial of oral contraceptives. Subsequently, she underwent ultrasound-guided transvaginal aspiration and sclerotherapy for uterine cystic adenomyosis. Approximately 90 mL of chocolate-colored fluid was aspirated from the mass and 20 mL of lauromacrogol was injected in the cyst. The reduction rates of the mass 3 and 12 months after the procedure were 92.01 and 99.10%, respectively. Her dysmenorrhea completely resolved. One and half year after the operation, she had a successful pregnancy and gave birth to a healthy baby through vagina.

Conclusion

The rare entity of uterine cystic adenomyosis can be treated safely and effectively by ultrasound-guided transvaginal aspiration and sclerotherapy.

Cystic adenomyoma surgery

OBJECTIVE

Cystic adenomyoma is a lesion located within the myometrium. It is lined with endometrium and has hemorrhagic content. This rare entity has been described as a focal form of adenomyosis. However, it is poorly understood, and the management of symptomatic patients is not codified. Our objective is to evaluate the effectiveness of treatment with planned surgery for cystic adenomyoma on symptoms and fertility in a retrospective series of patients.

STUDY DESIGN

This is a retrospective study between January 2011 and January 2018 in a university hospital of patients that had surgery for cystic adenomyoma with uterine preservation.

RESULTS

Pre-operative, per-operative, and post-operative data were recorded. Of the 18 patients included, 3 were lost to follow-up; 15 underwent laparoscopic surgery and 3 operative hysteroscopies. Complications during and after surgery were rare, involving only 3 patients, and of low severity. One patient saw no improvement in pain after surgery and 2 patients saw only partial improvement in their pain; 7 patients achieved at least one pregnancy with favorable outcome after surgery.

CONCLUSION

Based on this series, we argue that conservative surgical treatment for cystic adenomyoma generally improves pain and fertility without causing morbidity.

Minimally invasive management of juvenile cystic adenomyoma: report of three cases

Background

Juvenile cystic adenomyosis (JCA) represents a rare form of focal adenomyosis in young women.

Objectives

To determine safety and effectiveness of minimally invasive surgery (MIS for JCA).

Materials and Methods

Three patients aged 16-30 years old presented with chronic pelvic pain [2016 - 2019]. Hormonal treatment failed in two cases. Cystic lesions in the myometrium (n=2), and the broad ligament (n=1) was detected on transvaginal 2D ultrasound (TV 2D US) and/or magnetic resonance imaging (MRI). The cyst was separate from the endometrium in all the cases, within the myometrium in two patients and in the right broad ligament in one case. The cystic lesions were confirmed on laparoscopy; and laparoscopic excision of the cysts with adequate repair of the myometrial beds were performed in all cases with fertility preservation. Robotic assistance was chosen in one case in an attempt to avoid injury of the fallopian tube based on the cyst location during a previous laparoscopy. The endometrial cavity was entered in one case.

Main outcome measures

Absence of intraoperative complications and relief of presenting symptoms postoperatively.

Results

Pathology report confirmed the diagnosis of JCA is all cases. There were no intraoperative complications. All three patients reported relief of their symptoms 6 to 8 months after surgery. No recurrence of the JCA was reported using TV 2D US in all cases.

Conclusions

MIS could be the treatment of choice for patients with JCA. The technique described in our study is safe, effective, and easy to master in experienced hands.

What is new?

Value of MIS in treatment of patients with JCA.

A Feasible Technique in Laparoscopic Excision for Juvenile Cystic Adenomyosis: A Case Report, Literature Review, and Surgical Video

Background: Juvenile cystic adenomyosis (JCA) is a rare uterine lesion. We present the case of a young woman who was diagnosed with JCA and subsequently managed with laparoscopic cyst removal with sharp and blunt dissection. Moreover, we provide a literature review and a surgical video. Case: A 22-year-old nulliparous woman presented with severe dysmenorrhea and was assessed using contrast-enhanced abdominal computed tomography, transvaginal ultrasonography and pelvic magnetic resonance imaging, and diagnosed with a cystic lesion on the left side of the myometrium. She underwent laparoscopic cyst excision and uterine reconstruction. Histology was suggestive of JCA. The dysmenorrhea resolved postoperatively. Conclusion: Surgical resection is the first choice of treatment for cystic adenomyosis, and a laparoscopic approach using scissor forceps is effective.

Juvenile cystic adenomyoma, a rare diagnostic challenge: Case Reports and literature review

Objective

To report 2 very rare cases of young women who presented with severe dysmenorrhea and a large cystic lesion in the myometrium, which presented a diagnostic dilemma because they were confused with a Müllerian anomaly.

Design

Case reports and a literature review.

Setting

A university-based reproductive endocrinology and infertility clinic in the United States.

Patient(s)

An 18- and a 16-year-old nulliparous girl presented with worsening of their longstanding pelvic pain, and imaging study results were suggestive of a Müllerian anomaly.

Intervention(s)

Abdominal and pelvic computed tomography, transvaginal ultrasonography, pelvic magnetic resonance imaging, operative laparoscopy, and excision of a juvenile cystic adenomyoma (JCA).

Main Outcome Measure(s)

Resolution of the pelvic pain and restoration of normal uterine anatomy after appropriate intervention

Result(s)

Restoration of normal uterine anatomy, which was confirmed by 3-dimensional ultrasonography for case 1; however, case 2 still had a small remnant of JCA postoperatively.

Conclusion(s)

Clinical and radiologic examinations may not be useful in differentiating a Müllerian anomaly from other rare abnormalities like JCA. When in doubt, laparoscopy can assist in diagnosing and treating the condition.

Successful laparoscopic surgery of accessory cavitated uterine mass in young women with severe dysmenorrhea

Accessory cavitated uterine mass (ACUM) is a rare and unique condition seen in young women. We report cases of ACUMs in two patients, a 14-year-old girl and a 25-year-old woman, both with complaints of severe dysmenorrhea that had started at menarche and had progressively worsened since. A large cystic lesion was localized in the anterolateral wall of the myometrium separate from the endometrium, which was difficult to distinguish from congenital uterine anomalies. Laparoscopic excision of the ACUMs was successful and completely resolved the dysmenorrhea. Early investigation of severe dysmenorrhea in young women can provide appropriate management and relieve symptoms.

Laparoscopic treatment of a large cystic adenomyosis of the uterus: A case report

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Cystic adenomyosis is rarely reported in the medical literature.

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It is easy for clinicians to misdiagnose or miss the diagnosis because of its low incidence, rare clinical and atypical clinical features.

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In case of large cystic adenomyoma, the surgeon can diagnose and treate the patient with laparoscopic.

Introduction

We describe a patient with a large cystic adenomyosis of the uterus who was treated by a laparoscopic approach.

Case presentation

A 38-year-old woman presented with dysmenorrhoea for 4 months. A 104 mm × 55 mm × 60 mm cystic mass was detected on the right side of the posterior wall of the uterus by ultrasound. Laparoscopy was performed, during which a bumpy mass was discovered protruding from the surface of the uterine myometrium. Both ovaries were normal. When the wall of the cystic mass was opened, chocolate-colored fluid was visible. The cyst was completely removed, and postoperative histopathology confirmed a cystic adenomyosis. One month later, the uterus was found to be normal on ultrasound.

Discussion

Endometriosis is a common disease in women and is divided into ovarian endometrioid cysts, superficial endometriosis, deep infiltrating endometriosis and other special types according to pathological characteristics. As a special type of endometriosis, the incidence of cystic adenomyosis is low, and its specific incidence is unknown. Cystic adenomyosis is clinically characterized by the appearance of one or more cystic cavities between the walls of the uterine muscles.

Conclusion

Laparoscopic surgery is an effective method for the diagnosis and treatment of large cystic masses in the uterine myometrium.

Subserosal adenomyotic cysts and peritoneal inclusion cysts - Unusual differential diagnoses of multicystic pelvic masses: A review of two cases

Background

Multiloculated pelvic cysts are commonly misdiagnosed as ovarian tumors or malignancies. We report 2 patients diagnosed with subserosal adenomyotic cysts and peritoneal inclusion cysts, mimicking multiloculated pelvic tumors. We discuss their clinical presentation, investigations, operation findings, and histopathology, present a literature review.

Cases

Case 1 was a 44-year-old patient with abnormal uterine bleeding. Imaging showed an enlarging multiloculated cystic structure over the right uterine wall. She underwent a diagnostic laparoscopy and right salpingo-ophorectomy. Intra-operatively, she was found to have multiple subserosal uterine cysts, diagnosed as adenomyotic cysts on histology.

Case 2 was a 50-year-old patient with history of laparoscopic cystectomy done 20 years ago. She was incidentally found to have a multiloculated cystic lesion in the pelvis. The lesion was located midline, anterior and superior to the uterus and bladder. She underwent a total abdominal hysterectomy, bilateral salpingo-ophorectomy, and bladder peritonectomy. Intra-operatively, multiple cystic lesions were noted over the anterior and fundus of uterus, bladder peritoneum, and pelvic side walls. The condition was confirmed to be peritoneal inclusion cysts on histology.

Conclusion

Subserosal adenomyotic cysts are a rare presentation of adenomyosis. They typically occur in premenopausal women. Treatment is usually by hormonal medications or surgical excision.

Many patients with peritoneal inclusion cysts have a history of peritoneal insults. Surgical excision is the most commonly described management as they often mimic malignancy. Both conditions are unusual presentations of multiloculated pelvic masses. A high recurrence rate is found, hence long-term follow-up with imaging is essential.

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Adenomyotic cysts can present as multiple cystic lesions found within the uterine myometrium, submucosal or subserosal layers, lined with endometrial epithelium and stroma.

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Patients with adenomyotic cysts commonly present with dysmenorrhoea or dysfunctional uterine bleeding. These cysts are usually excised surgically or treated with hormonal methods.

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Peritoneal inclusions cysts are benign aggregate masses of variable sized, fluid-filled, mesothelial lined cysts of the pelvis and abdomen, commonly with a history of previous insult to the peritoneum

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Surgical excision of the peritoneal inclusion cysts is the most common treatment option, often for histological diagnosis as it mimics malignancy.

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Recurrence is common for both conditions, hence long term follow ups with imaging should be considered.

Juvenile cystic adenomyosis: A case report and review of the literature

This report describes a case of a uterine cystic myometrial lesion in a 16-year-old adolescent girl presenting with pelvic pain and severe progressively worsening dysmenorrhoea. Patient's symptoms, ultrasound and MRI were suggestive of juvenile cystic adenomyosis (JCA). Medical treatment and alcohol sclerotherapy had a moderate and transient effect. The symptoms rapidly recurred, and the lesion was successfully excised via laparoscopic surgery. The treatment of JCA depends on patient's age, the symptoms' severity and the cyst location. Although rare, juvenile cystic adenomyosis should be considered in young women with severe dysmenorrhoea.

Ultrasound diagnosis of endometriosis and adenomyosis: State of the art

Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.

From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis

Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.