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Ren XC, Liu W, Hu LR, Mao M. Mesothelial cyst of uterus in a nullipara patient: A case report. Medicine (Baltimore) 2023; 102:e33159. [PMID: 36862889 PMCID: PMC9981359 DOI: 10.1097/md.0000000000033159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Uterine mesothelial cysts represent a diagnostic challenge because of their low incidence, with very few cases reported in the English literature. PATIENT CONCERNS We report the case of a 27-year-old nullipara woman complaining of self-discovery of a mass in the abdomen for 1 week. Supersonic examination revealed a pelvic cystic lesion measuring 8.9 × 8.2 cm. The patient underwent exploratory single-port laparoscopic surgery and had a large uterine cystic mass located within the posterior wall of the uterus. DIAGNOSIS After excision of the uterine cyst, the final histopathological diagnosis was uterine mesothelial cyst. INTERVENTIONS We treated her with a single-port laparoscopic uterine cystectomy. OUTCOMES Close follow-up of the case for 2 years showed that the patient was free of any symptoms, and no recurrence was noted. LESSONS Uterine mesothelial cysts are extremely rare. They are often misdiagnosed by clinicians as extrauterine masses or cystic degeneration of leiomyomas. This report aims to share a rare case of uterine mesothelial cyst and improve gynecologists' academic vision of the disease.
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Affiliation(s)
- Xiu-Cong Ren
- Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Wei Liu
- Department of Pathology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Li-Rong Hu
- Department of Ultrasound, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Min Mao
- Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
- * Correspondence: Min Mao, Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China (e-mail: )
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2
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Zhao X, Yang Y. Ultrasound-Guided Transvaginal Aspiration and Sclerotherapy for Uterine Cystic Adenomyosis: Case Report and Literature Review. Front Med (Lausanne) 2022; 9:764523. [PMID: 35308513 PMCID: PMC8928164 DOI: 10.3389/fmed.2022.764523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Xinxin Zhao
- Department of Hospice, Sheng Jing Hospital of China Medical University, Shenyang, China
| | - Ye Yang
- Department of Ultrasound, Sheng Jing Hospital of China Medical University, Shenyang, China
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3
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Gundogdu F, Orhan N, Ozgul N, Usubutun A. Recurrent mucinous neoplasm arising in cesarean scar: A case report and review of literature. Int J Gynaecol Obstet 2021; 157:564-567. [PMID: 34498288 DOI: 10.1002/ijgo.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
Ovarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37-year-old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingo-oophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented.
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Affiliation(s)
- Fatma Gundogdu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nazlı Orhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Akkour K, Alhulwah M, Alqahtani N, Arafah MA. A Giant Leiomyoma with Massive Cystic Hydropic Degeneration Mimicking an Aggressive Neoplasm: A Challenging Case with a Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929085. [PMID: 33785706 PMCID: PMC8019839 DOI: 10.12659/ajcr.929085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Female, 32-year-old Final Diagnosis: Leiomyoma with massive cystic hydropic degeneration Symptoms: Abdominal distension • abdominopelvic mass • pelvic pain • urinary frequency Medication: — Clinical Procedure: Surgery Specialty: Obstetrics and Gynecology • Pathology • Surgery
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Affiliation(s)
- Khalid Akkour
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mais Alhulwah
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nayef Alqahtani
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maria A Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Malhotra V, Dahiya S, Nanda S, Chauhan M, Bhuria V. Accessory and Cavitated Uterine Mass: Is It a Müllerian-Duct Anomaly? J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vani Malhotra
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sonia Dahiya
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Meenakshi Chauhan
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vandana Bhuria
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Protopapas A, Kypriotis K, Chatzipapas I, Kathopoulis N, Sotiropoulou M, Michala L. Juvenile Cystic Adenomyoma vs Blind Uterine Horn: Challenges in the Diagnosis and Surgical Management. J Pediatr Adolesc Gynecol 2020; 33:735-738. [PMID: 32827760 DOI: 10.1016/j.jpag.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Juvenile cystic adenomyomas (JCAs) are rare uterine lesions. Differential diagnosis might be difficult. We present the case of an adolescent who was diagnosed with JCA and was managed with laparoscopic excision. CASE A 14-year-old patient with complaint of menarche with excruciating dysmenorrhea, was diagnosed using magnetic resonance imaging with a uterine anomaly consisting of a normal right hemiuterus, and a left cystic lesion with surrounding hypotense myometrium. She was managed with laparoscopic excision of the left side, and uterine reconstruction. Histology was suggestive of JCA, associated with diffuse adenomyosis. Dysmenorrhea improved considerably after surgery. SUMMARY AND CONCLUSION Differential diagnosis between cystic uterine lesions relies on clinical, imaging, and perioperative clues that might assist in their formal classification. Doubt might still remain in some cases.
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Affiliation(s)
- Athanasios Protopapas
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos Kypriotis
- Pediatric and Adolescent Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Lina Michala
- Pediatric and Adolescent Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
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7
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Peyron N, Jacquemier E, Charlot M, Devouassoux M, Raudrant D, Golfier F, Rousset P. Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity. Eur Radiol 2018; 29:1144-1152. [PMID: 30159623 DOI: 10.1007/s00330-018-5686-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations. METHODS Eleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings. RESULTS All 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17-60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis. CONCLUSIONS On MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. KEY POINTS • ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. • Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament. • On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.
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Affiliation(s)
- N Peyron
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - E Jacquemier
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - M Charlot
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - M Devouassoux
- Pathology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 Claude Bernard University, Lyon, France
| | - D Raudrant
- Lyon 1 Claude Bernard University, Lyon, France.,Gynaecology and Obstetrics Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - F Golfier
- Lyon 1 Claude Bernard University, Lyon, France.,Gynaecology and Obstetrics Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - P Rousset
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Lyon 1 Claude Bernard University, Lyon, France.
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Jackson-Humbles DN, Seely JC, Herbert RA, Malarkey DE, McIntyre BS, Foster PM, Dixon D. Uterine Paramesonephric Cysts in Sprague-Dawley Rats from National Toxicology Program Studies. Toxicol Pathol 2018; 46:421-430. [PMID: 29706125 DOI: 10.1177/0192623318772487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital uterine wall cysts arising from paramesonephric (Müllerian) and mesonephric (Wolffian) ducts are typically incidental findings in most species. We used immunohistochemistry to characterize and determine the origin of uterine cysts in Sprague-Dawley (SD) rats from multigeneration studies conducted by the National Toxicology Program. Subserosal uterine cysts were observed in 20 of the 2,400 SD rats evaluated in five studies, and 10 cysts were characterized for this study. Single cysts were unilocular, fluid-filled, and occurred throughout the uterus. Microscopically, all cysts had a well-developed smooth muscle wall, lined by flattened to cuboidal, sometimes ciliated, epithelium that stained intensely positive for cytokeratin 18 and paired box protein 8 (PAX8). Most cyst epithelia displayed weak to moderate positivity for progesterone receptor (PR) and/or estrogen receptor α (ER-α), as well as were negative for GATA binding protein 3 (GATA3). Cyst lumens contained basophilic flocculent material. The cysts appeared to be developmental anomalies arising from paramesonephric tissue based on positive PAX8 and ER-α and/or PR staining. Additionally, 70% of the cysts lacked GATA3 expression. Taken together, the subserosal uterine cysts observed in adult rats in these studies most likely arose from the paramesonephric duct.
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Affiliation(s)
- Daven N Jackson-Humbles
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - John Curtis Seely
- 2 Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina, USA
| | - Ronald A Herbert
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - David E Malarkey
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Barry S McIntyre
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Paul M Foster
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Darlene Dixon
- 1 Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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9
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The Curious Case of the Uterine Cyst. J Minim Invasive Gynecol 2016; 24:884-885. [PMID: 28007590 DOI: 10.1016/j.jmig.2016.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022]
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10
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Fuseini NM, Shlansky-Goldberg RD, Neff PM. Ultrasound-guided drainage and sclerosis of a cystic myometrial mass. J OBSTET GYNAECOL 2016; 37:127-128. [DOI: 10.1080/01443615.2016.1229275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nurain M. Fuseini
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA
| | | | - Pamela M. Neff
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA
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11
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Raga F, Llinares C, Cholvi S, Bonilla F, Pascual C, Cano A. HDlive imaging of cystic uterine leiomyoma degeneration. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:655-656. [PMID: 26287821 DOI: 10.1002/uog.15727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 06/04/2023]
Affiliation(s)
- F Raga
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
- Departamento de Obstetricia y Ginecología, Universidad de Valencia, Avd. Blasco Ibañez nº 15, 46010, Valencia, Spain
| | - C Llinares
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
| | - S Cholvi
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
| | - F Bonilla
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
- Departamento de Obstetricia y Ginecología, Universidad de Valencia, Avd. Blasco Ibañez nº 15, 46010, Valencia, Spain
| | - C Pascual
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
| | - A Cano
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario, Valencia, Spain
- Departamento de Obstetricia y Ginecología, Universidad de Valencia, Avd. Blasco Ibañez nº 15, 46010, Valencia, Spain
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Brosens I, Gordts S, Habiba M, Benagiano G. Uterine Cystic Adenomyosis: A Disease of Younger Women. J Pediatr Adolesc Gynecol 2015; 28:420-6. [PMID: 26049940 DOI: 10.1016/j.jpag.2014.05.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW We adopted a life-cycle approach to further our understanding of the natural history of the cystic forms of uterine adenomyosis first described by Cullen in 1908. SEARCH STRATEGY Scopus and PubMed were searched for all terms referring to cystic variant of adenomyosis or adenomyoma. References found in major publications were also included in the review. MAIN FINDINGS With the introduction of non-invasive imaging techniques, a number of cases of cystic variants of adenomyosis have been reported. Progressive, severe, medication-resistant dysmenorrhea is the main clinical feature but delay in diagnosis remains problematic. The life-cycle approach demonstrates that cystic adenomyosis is more relevant to adolescent and young adulthood. Congenital müllerian and wolffian cysts and the uterus-like masses are more frequent in women >30 years of age. The latter is frequently located outside the uterus and may represent a form of endometriosis rather than adenomyosis. Differential diagnosis includes ovarian cysts and congenital uterine anomalies. Menstruation suppression with continuous oral contraceptive pill with ultrasonographic monitoring of cyst regression may prove successful in the young woman, but surgical excision using minimally invasive endoscopy is highly effective. The various terms used in literature to describe these lesions cause considerable confusion. Here we propose a classification into 3 subtypes and standardized reporting criteria to enable comparison. CONCLUSIONS Endometrial lined myometrial cysts are almost specific to adolescent and young women. We propose a new classification system.
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Affiliation(s)
- Ivo Brosens
- Catholic University of Leuven, Leuven, Belgium.
| | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Marwan Habiba
- Reproductive Sciences Section, University of Leicester and University Hospitals of Leicester, Leicester, UK
| | - Giuseppe Benagiano
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
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Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril 2014; 101:472-87. [DOI: 10.1016/j.fertnstert.2013.10.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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15
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Takeda A, Imoto S, Sugiyama C, Nakamura H. Uterine Adenomyoma With Exophytic Subserosal Growth: Case Report of Rare Manifestation With Image Diagnosis and Laparoscopic-Assisted Excision. J Minim Invasive Gynecol 2013; 20:717-22. [DOI: 10.1016/j.jmig.2013.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 11/30/2022]
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Nakae H, Osuga Y, Fujimoto A, Nakagawa S, Ichinose M, Yano T, Taketani Y. Müllerian cyst of the uterus treated with laparoscopy and diagnosed using immunohistology. J Obstet Gynaecol Res 2012; 39:430-3. [DOI: 10.1111/j.1447-0756.2012.01968.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus. Obstet Gynecol 2010; 116:1101-9. [PMID: 20966695 DOI: 10.1097/aog.0b013e3181f7e735] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present clinical cases of women who had an accessory and cavitated noncommunicating uterine mass with functioning endometrium associated with a normal uterus, suggestive of a new type of Müllerian anomaly. METHODS We report on five institutional cases: four cases of cavitated accessory uterine mass and a case of true adenomyoma. A review of the literature was performed by looking for these terms and others related in MEDLINE. RESULTS Including ours, there are 18 cases in the literature showing an accessory cystic cavity lined by endometrioid epithelium with an otherwise normal uterus. Another 11 cases only partially fulfilled the inclusion criteria. All of the first cases were in young women presenting with severe dysmenorrhea (n=4). Generally, the tumor was located in the anterior wall of the uterus at the level of insertion of the round ligament. It presents a certain similarity with the cavitated true adenomyomas observed in older women in whom the endometrial lining of the cystic cavity is generally absent. For differential diagnosis with cavitated noncommunicating rudimentary uterine horns, hysterosalpingography showing a normal eutopic uterine cavity is decisive. CONCLUSION Noncommunicating accessory uterine cavities and isolated cystic adenomyomas correspond to the same pathology: cavitated accessory uterine mass associated with an otherwise normal uterus. They present problems of differential diagnosis with true cavitated adenomyomas and cavitated rudimentary uterine horns. Accessory uterine mass could be caused by duplication and persistence of ductal Müllerian tissue in a critical area at the attachment level of the round ligament, possibly related to a gubernaculum dysfunction. LEVEL OF EVIDENCE III.
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Raga F, Sanz-Cortés M, Casañ EM, Burgues O, Bonilla-Musoles F. Cotyledonoid dissecting leiomyoma of the uterus. Fertil Steril 2009; 91:1269-70. [DOI: 10.1016/j.fertnstert.2008.08.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/21/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
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Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online 2008; 17:244-8. [PMID: 18681999 DOI: 10.1016/s1472-6483(10)60201-5] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Modern imaging techniques allow non-invasive diagnosis of adenomyosis, a relatively common disorder characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with hyperplasia of the adjacent smooth muscle. The study of adenomyosis is greatly hampered by a lack of clear terminology and the absence of a consensus classification of the lesions. Any classification of adenomyosis must begin with an evaluation of the myometrium underlying the endometrium, the so-called junctional zone, since homogeneous thickening of this zone has become the standard criterion for non-invasive diagnosis. Although transvaginal sonography is useful for the detection of adenomyosis, the technique is highly operator dependent. Magnetic resonance imaging provides superior soft tissue resolution and currently represents the most accurate technique for non-invasive diagnosis. Adenomyosis represents a spectrum of lesions, ranging from increased thickness of the junctional zone to overt adenomyosis and adenomyomas, which in turn can be subclassified. It is increasingly recognized that adenomyosis is often associated with pelvic endometriosis yet the contribution of myometrial lesions to clinical symptoms, such as infertility and pain, remains poorly understood. Moreover, recent studies indicate that adenomyosis is a progressive disease that changes in appearance during the reproductive years. A consensus classification of uterine adenomyosis is urgently required.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
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