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Timmerman S, Stubbe L, Van den Bosch T, Van Schoubroeck D, Tellum T, Froyman W. Accessory cavitated uterine malformation (ACUM): A scoping review. Acta Obstet Gynecol Scand 2024; 103:1036-1045. [PMID: 38345425 PMCID: PMC11103141 DOI: 10.1111/aogs.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Accessory cavitated uterine malformation (ACUM) is a relatively recent term used to describe a noncommunicating, accessory uterine cavity. ACUM have been published under different terms ranging from juvenile cystic adenomyosis to "uterus-like mass". The objective of this study was to systematically identify all cases of ACUM and definitions described in the literature, regardless of label, and identify morphological, epidemiological, and clinical characteristics as well as management, while also highlighting knowledge gaps. MATERIAL AND METHODS A systematic literature search of three databases was performed, reviewing all records of cystic myometrial lesions. Cases that fitted common definitions for ACUM were included and clinical and imaging characteristics were documented in detail. This work was registered to PROSPERO and reporting followed PRISMA guidelines for scoping reviews. RESULTS A total of 53 articles were included, comprising 115 cases that met the minimal criteria for ACUM. The median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. A total of 19 women were parous. On ultrasound, ACUM appears as unilocular myometrial cysts, usually with ground-glass content. Hemorrhagic content is also observed on magnetic resonance imaging (MRI), with high signal intensity on both T2 and T1-weighted images. Ninety-five (83%) cases were managed surgically, with a trend towards primary nonsurgical options. Although no adverse outcomes were reported, long-term follow-up on subsequent fertility and pregnancy was rare. CONCLUSIONS Despite its increasing recognition as a clinical entity, ACUM often remains underdiagnosed as it shares similarities with other myometrial masses. We propose a unified terminology and definition for ACUM based on the data in this review. ACUM presents as a cavitated lesion, surrounded by a myometrial mantle, in continuity with the anterolateral uterine wall and located beneath the insertion of the round ligament and the interstitial portion of the fallopian tube. In contrast to other uterine abnormalities, a normal uterine cavity is visualized. Future studies are needed, using a clear definition for ACUM, and prospectively investigating management strategies, including long-term follow-up of patient-reported symptoms, fertility, and pregnancy outcomes.
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Affiliation(s)
- Stefan Timmerman
- Department of Development and Regeneration, KU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Lauren Stubbe
- Department of Development and Regeneration, KU LeuvenLeuvenBelgium
| | - Thierry Van den Bosch
- Department of Development and Regeneration, KU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Dominique Van Schoubroeck
- Department of Development and Regeneration, KU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Tina Tellum
- Department of GynecologyOslo University HospitalOsloNorway
| | - Wouter Froyman
- Department of Development and Regeneration, KU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
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Zhang L, Guo Z, Pang Y, Zhao J, Liang J, Ma X. Cystic adenomyoma of the uterus: Case report and literature review. Open Life Sci 2024; 19:20220846. [PMID: 38756858 PMCID: PMC11097041 DOI: 10.1515/biol-2022-0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/15/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
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.
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Affiliation(s)
- Lei Zhang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
| | - Zhaojun Guo
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
| | - Yicun Pang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
| | - Jun Zhao
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
| | - Jun Liang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
| | - Xiaolin Ma
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, No.139 of Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province 050051, China
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Deng F, Liu K, Huang Y, Chen Q, Wang L, Xiao X, Zhang L. Successful treatment of a rare giant accessory cavitated uterine mass: a case report. J Int Med Res 2024; 52:3000605241252238. [PMID: 38759222 PMCID: PMC11107332 DOI: 10.1177/03000605241252238] [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: 12/29/2023] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
An accessory cavitated uterine mass (ACUM) is a very rare obstructive genital malformation characterized by pelvic pain and severe dysmenorrhea. It is easily mistaken for other obstructive genital malformations in women, such as cystic uterine adenomyosis or cystic degeneration of uterine fibroids. This case report describes a 30-year-old patient with a huge uterine cornual mass. Successful resection was performed by surgical excision, and the lesion was diagnosed as an ACUM. Given the rarity of a giant ACUM, this report also includes a brief review of the relevant literature.
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Affiliation(s)
- Fenglian Deng
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Ke Liu
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Yanzhuo Huang
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Qiuling Chen
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Lijuan Wang
- Department of Pathology, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Xinqi Xiao
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
| | - Lu Zhang
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing Traditional Chinese Medicine Academy, Chongqing, China
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Moawad G, Youssef Y, Fruscalzo A, Faysal H, Merida M, Pirtea P, Guani B, Ayoubi JM, Feki A. The Impact of Conservative Surgical Treatment of Adenomyosis on Fertility and Perinatal Outcomes. J Clin Med 2024; 13:2531. [PMID: 38731060 PMCID: PMC11084146 DOI: 10.3390/jcm13092531] [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: 01/18/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
Adenomyosis is a benign condition commonly encountered in patients with infertility. While the definitive surgical management is hysterectomy, conservative surgical management is gaining attention in patients desiring future fertility. This review explores whether the surgical treatment of adenomyosis affects fertility outcomes for patients trying to conceive. The PubMed and Medline databases were searched using the keywords: "adenomyosis", "surgery", "radiofrequency", "infertility", "pregnancy", "sterility", "conception", "miscarriage", and "endometrial receptivity". Abstracts were screened, and relevant articles were selected for review. This review reveals that surgery appears to improve fertility outcomes with or without medical therapy; however, the risk of uterine rupture remains high and the best technique to reduce this risk is still not known. More studies are needed to formulate the best surgical approach for preserving fertility in treating adenomyosis and to establish standardized guidelines.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC 20037, USA
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Hani Faysal
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46204, USA
| | - Manuel Merida
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Faculté de Médecine Paris, Hopital Foch, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Faculté de Médecine Paris, Hopital Foch, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
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Verta S, Brambs CE, Christmann C. Cystic Adenomyoma in Pregnancy: A Case Report. Int J Womens Health 2024; 16:421-432. [PMID: 38469356 PMCID: PMC10926917 DOI: 10.2147/ijwh.s450701] [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: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Cystic adenomyomas (CA) are rare. They primarily affect adolescents and young women in their fertile years. Therefore, fertility and pregnancy outcome are of pivotal relevance in this patient collective. Apart from the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) on the management of endometriosis in general, there are no specific treatment recommendations for CA and, as far as our research shows, no data illustrating the behavior of a CA over the course of pregnancy. Thus, we report the case of a 32-year-old 1-gravida, 1-para, preconceptionally diagnosed with a CA by ultrasound. After thoroughly discussing further treatment options, the decision was made to opt for a more conservative approach and not perform surgery before attempting a next pregnancy. The patient conceived spontaneously and sonographic monitoring of the CA throughout pregnancy showed complete regression of the cystic component during the second trimester. A healthy baby was delivered at term by an uncomplicated elective cesarean section. Following a review of the literature and taking into account the course of our case, we propose the feasibility of a conservative, non-surgical approach in women with a CA and the desire to conceive.
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Affiliation(s)
- Stephanie Verta
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Christine E Brambs
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Corina Christmann
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Wang L, Li L, Xu D. A Case of Hysteroscopic Treatment of Cystic Adenomyosis. J Minim Invasive Gynecol 2023; 30:941-943. [PMID: 37709130 DOI: 10.1016/j.jmig.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/27/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Lijuan Wang
- Department of Gynecology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Linhan Li
- Department of Gynecology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Dianbo Xu
- Department of Gynecology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
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Janicas C, Cunha TM. Adenomyosis at a Glance: An Integrated Review of Transvaginal Ultrasound and MR Imaging Findings. Curr Probl Diagn Radiol 2023; 52:412-417. [PMID: 37230885 DOI: 10.1067/j.cpradiol.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Adenomyosis is a benign uterine disorder increasingly recognized in premenopausal women. Given its significant clinical burden, an accurate noninvasive diagnosis is paramount. Both transvaginal ultrasound (TVUS) and magnetic resonance (MR) provide an adequate assessment of adenomyosis, the former being recommended for first-line imaging evaluation and the latter being mainly used as a problem-solving technique. In this article, the authors review the TVUS and MR imaging findings of adenomyosis while referring to their histopathological background. Whereas direct signs correlate directly to ectopic endometrial tissue and are highly specific to adenomyosis, indirect signs result from myometrial hypertrophy and increase diagnostic sensitivity. Potential pitfalls, differential diagnoses, and frequently associated estrogen-dependent conditions are also discussed.
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Affiliation(s)
- Catarina Janicas
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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8
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Dekkiche S, Dubruc E, Kanbar M, Feki A, Mueller M, Meuwly JY, Mathevet P. Accessory and cavitated uterine masses: a case series and review of the literature. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1197931. [PMID: 37662068 PMCID: PMC10469797 DOI: 10.3389/frph.2023.1197931] [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: 03/31/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023] Open
Abstract
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.
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Affiliation(s)
- S. Dekkiche
- Gynaecology Department, Department Women-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E. Dubruc
- Institute of Pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - M. Kanbar
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - A. Feki
- Department of Obstetrics and Gynaecology, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
| | - M. Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - J-Y. Meuwly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
| | - P. Mathevet
- Gynaecology Department, Department Women-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
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Gkrozou F, Vatopoulou A, Skentou C, Paschopoulos M. Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature. Diagnostics (Basel) 2023; 13:2182. [PMID: 37443576 DOI: 10.3390/diagnostics13132182] [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: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies. MATERIAL AND METHODS The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy. RESULTS The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection. CONCLUSIONS Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Chara Skentou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
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Liu Y, Cheng Y, Li W, Pan Y, Tao X. A novel and rare diverticulum-like adenomyosis: A case report. Int J Surg Case Rep 2023; 108:108420. [PMID: 37384956 PMCID: PMC10382757 DOI: 10.1016/j.ijscr.2023.108420] [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: 05/13/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Cystic adenomyosis is a rare variant of adenomyosis, with only 90 reported cases found in the literature so far. Diverticulum-like adenomyosis is even more uncommon, with only one documented case to date. CASE PRESENTATION We report the case of a 42-year-old asymptomatic woman who had an incidental finding of a parauterine cyst on an abdominal computed tomography scan. B-ultrasonography also revealed an endometriotic cyst. Further MRI revealed a cystic lesion measuring 7.6 × 6.1 × 7.7 cm that communicated with the uterine cavity through a tiny channel. The fluid in the cyst showed high signal intensity on T1-weighted image (T1WI), and the cyst wall showed a marked low signal intensity on T2-weighted image (T2WI). No other masses were found on either side. After obtaining informed consent, we performed a laparoscopic exploration on the patient, where it became apparent that the 7.6 × 6.1 × 7.7 cm cystic mass was located on the left uterine isthmus-the excised lesion contained chocolate-like fluid within a thickened wall. Pathological examination revealed typical endometrial glands and interstitial tissues in the cystic wall. DISCUSSION Cystic adenomyosis is a rare benign lesion in women of reproductive age that is known to cause hypermenorrhea, dysmenorrhea, and abnormal uterine bleeding. Our case represents the second documented case of diverticulum-like adenomyosis. However, the patient in our case did not exhibit abnormal uterine bleeding or dysmenorrhea. One possible explanation for this finding is that the sinus tract was too small to cause blood influx into the uterine cavity. CONCLUSION Our case report provides valuable insights for clinicians to better understand this uncommon disease and reduce the incidence of misdiagnosis.
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Affiliation(s)
- Yanyun Liu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China
| | - Yali Cheng
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China
| | - Weibo Li
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China
| | - Yihong Pan
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China.
| | - Xiaoling Tao
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China
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Liu X, Wang J, Liu Y, Luo S, Yan G, Yang H, Wan L, Huang G. High Intensity Focused Ultrasound Ablation for Juvenile Cystic Adenomyosis: Two Case Reports and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13091608. [PMID: 37174999 PMCID: PMC10178475 DOI: 10.3390/diagnostics13091608] [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: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Cystic adenomyosis is a rare type of uterine adenomyosis, mainly seen in young women, which is often characterized by severe dysmenorrhea. The quality of life and reproductive function of young women could be affected by misdiagnosis and delayed treatment. At present, there are no universal guidelines and consensus. We report two cases of patients with cystic adenomyosis in juveniles treated with high-intensity focused ultrasound (HIFU) ablation. In the first case, magnetic resonance imaging (MRI) indicated a cystic mass of 2.0 cm × 3.1 cm × 2.4 cm in the uterus. After she underwent HIFU treatment, her pelvic MRI showed a mass of 1.1 × 2.4 cm in size, and her dysmenorrhea symptoms gradually disappeared. In the second case, a pelvic MRI indicated a 5.1 cm × 3.3 cm × 4.7 cm cystic mass in the uterus. After she underwent HIFU and combined four consecutive cycles of GnRH-a treatment, the lesion shrunk 1.2 cm ×1.4 cm × 1.6 cm, without dysmenorrhea. Simultaneously, the report reviewed 14 cases of juvenile cystic adenomyosis over the last ten years. HIFU or HIFU-combined drugs were safe and effective in treating juvenile cystic adenomyosis, but multicenter and prospective studies may be necessary to validate this in the future.
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Affiliation(s)
- Xin Liu
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Jingxi Wang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Yanglu Liu
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
| | - Shuang Luo
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Gaowu Yan
- Department of Radiology and Imaging, Suining Central Hospital, Suining 629000, China
| | - Huaqi Yang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Lili Wan
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Guohua Huang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
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Mahey R, Cheluvaraju R, Kumari S, Kachhawa G, Kumari A, Rajput M, Bhatla N. Robert's Uterus versus Juvenile Cystic Adenomyoma - Diagnostic and Therapeutic Challenges - Case Report and Review of Literature. J Hum Reprod Sci 2023; 16:79-86. [PMID: 37305779 PMCID: PMC10256944 DOI: 10.4103/jhrs.jhrs_10_23] [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: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/13/2023] Open
Abstract
This case report highlights the diagnostic dilemma and therapeutic challenges encountered while managing adolescent girls with progressive dysmenorrhoea and management of Robert's uterus. Two girls aged 20 years and 13 years presented with severe progressive dysmenorrhoea. In the first case, laparoscopy revealed juvenile cystic adenomyoma (JCA) of 3 cm × 3 cm on the left side anteroinferior to the round ligament. Laparoscopic resection of the lesion was done, and histopathology revealed features of adenomyosis. In the second case, there was a globular enlargement of the right half of the uterine body with round ligament and adnexa attached to the lesion (Robert's uterus). In view of severe symptoms, complete resection of the lesion and partial resection of hemi-uterus was done, followed by myometrial defect closure. Both cases were initially diagnosed as JCA, and the final diagnosis was made on laparoscopy. Both girls had complete symptomatic relief from the next menstrual cycle and have been under follow-up for 24 months and 18 months, respectively. Due to the rarity of conditions, Robert's uterus and JCA are usually misdiagnosed with each other or with other Mullerian anomalies such as a non-communicating unicornuate uterus. Radiologists and clinicians should be aware of these different pathologies causing similar symptoms. Understanding the pathology, early diagnosis, timely referral and correct surgical procedure are emphasised to improve reproductive outcomes.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Orlando MS, Carey-Love A, Attaran M, King CR. Surgical techniques for excision of juvenile cystic adenomyoma. Fertil Steril 2022; 118:810-811. [PMID: 35931491 DOI: 10.1016/j.fertnstert.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To review causes of pelvic pain among adolescents and discuss surgical techniques for safe and effective resection of juvenile cystic adenomyomas. DESIGN Case report. SETTING Academic medical center. PATIENTS We present a 16-year-old patient with chronic pelvic pain and ultrasound evidence of a 2.4 cm adenomyoma. The lesion was thought specifically to represent a juvenile cystic adenomyoma, defined as a cystic lesion >1 cm occurring in women younger than 30 years with severe dysmenorrhea that is distinct from the uterine cavity and surrounded by hypertrophic myometrium. INTERVENTION Given minimal relief from medical therapy and high suspicion for coexistent endometriosis, our patient elected to undergo laparoscopic resection of adenomyoma and excision of pelvic lesions. MAIN OUTCOME MEASURES Preoperative considerations discussed in this video include imaging to identify the location of the lesion and adjacent structures, such as the uterine vessels, discontinuation of gonadotropin-releasing hormone agonist for adequate intraoperative visualization, and the high likelihood of encountering endometriosis at operation. RESULTS We review the following surgical techniques: maximize visualization with the use of a uterine manipulator and temporary oophoropexy, optimize hemostasis via temporary uterine artery ligation and control of collateral blood vessels, complete ureterolysis, meticulous enucleation of adenomyoma, and excision of coexistent endometriotic lesions. Surgical findings demonstrated a 2 cm lesion along the left lower uterine segment and red-brown lesions along bilateral ovarian fossa, pathologically confirmed as adenomyoma and superficial endometriosis, respectively. CONCLUSION This video presents strategies for safe and effective adenomyoma resection and treatment of refractory chronic pelvic pain in an adolescent.
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Affiliation(s)
- Megan S Orlando
- Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Angelina Carey-Love
- Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marjan Attaran
- Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Cara R King
- Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Zvizdic Z, Sefic-Pasic I, Ibisevic N, Murtezic S, Vranic S. Large uterine juvenile cystic adenomyoma in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Xu T, Li Y, Jiang L, Liu Q, Liu K. Subserous Cystic Adenomyosis: A Case Report and Review of the Literature. Front Surg 2022; 9:807676. [PMID: 35433801 PMCID: PMC9008365 DOI: 10.3389/fsurg.2022.807676] [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] [Received: 11/02/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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16
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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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17
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Kerbage Y, Dericquebourg S, Collinet P, Verpillat P, Giraudet G, Rubod C. Cystic adenomyoma surgery. J Gynecol Obstet Hum Reprod 2022; 51:102313. [PMID: 35031510 DOI: 10.1016/j.jogoh.2022.102313] [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: 08/06/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Yohan Kerbage
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France.
| | - Sarah Dericquebourg
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Pierre Collinet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
| | | | - Géraldine Giraudet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Chrystèle Rubod
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
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18
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Tokgoz VY, Tekin AB. A rare case of the new entity of müllerian anomalies mimicking the noncommunicating rudimentary cavity with hemi-uterus: accessory cavitated uterine mass. Fertil Steril 2022; 117:646-648. [DOI: 10.1016/j.fertnstert.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
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19
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Said MR, Afaneh H, Zaghmout O, Moses K, Young OJ, Abuzeid MI. Minimally invasive management of juvenile cystic adenomyoma: report of three cases. Facts Views Vis Obgyn 2021; 13:267-272. [PMID: 34555881 PMCID: PMC8823274 DOI: 10.52054/fvvo.13.3.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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20
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Mollion M, Host A, Faller E, Garbin O, Ionescu R, Roy C. Report of two cases of Accessory Cavitated Uterine Mass (ACUM): Diagnostic challenge for MRI. Radiol Case Rep 2021; 16:3465-3469. [PMID: 34527125 PMCID: PMC8430264 DOI: 10.1016/j.radcr.2021.07.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Cystic adenomyosis is an unusual form of adenomyosis, characterized by a well-circumscribed cavitated endometrial gland and stroma, ≥ 1 cm in diameter, located within the myometrium. Few cases have been reported in the gynecological literature, with confusing naming such as: juvenile cystic adenomyosis, cystic myometrial lesions, cystic adenomyoma or juvenile adenomyotic cysts. The current preferred terminology is accessory cavitated uterine mass /or malformation (ACUM). We report here the cases of two 17 and 18 -year-old nulliparous women, who complained of severe dysmenorrhea early after the onset of menarche, with none or partial efficiency of medical treatment. MRI findings, with a follow-up in one case and surgical treatment in both cases, are described with an emphasis on physiopathology. The typical MR appearance is a large well-circumscribed round mass within the external myometrium, composed by an inner cystic hemorrhagic layer surrounded by a thick fibrous crown. The first-line treatment is laparoscopic surgery with mass resection. This typical MRI pattern must be a part of the knowledge of the radiologists.
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Affiliation(s)
- Mélanie Mollion
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
| | - Aline Host
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Emilie Faller
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Olivier Garbin
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Raluca Ionescu
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
| | - Catherine Roy
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
- Department of Gynecology, Strasbourg University Hospital - Obstetric Medico-Surgical Center (CMCO), 67303 Schiltigheim Cedex, France
- Corresponding author.
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21
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A Feasible Technique in Laparoscopic Excision for Juvenile Cystic Adenomyosis: A Case Report, Literature Review, and Surgical Video. ENDOCRINES 2021. [DOI: 10.3390/endocrines2030026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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22
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Yau K, Jarin J. Juvenile Cystic Adenomyoma Mimicking a Degenerating Leiomyoma. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kimberly Yau
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Jarin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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23
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Zhao CZ, Wang B, Zhong CY, Lu ST, Lei L. Management of uterine cystic adenomyosis by laparoscopic surgery: case report. BMC WOMENS HEALTH 2021; 21:263. [PMID: 34210307 PMCID: PMC8246681 DOI: 10.1186/s12905-021-01341-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
Background Endometriosis of the uterine body can be manifested as diffuse solid lesions or cystic lesions. The former is common, while the latter is rare, especially for cystic adenomyosis larger than 5 cm. Case presentation A 30-year-old woman was admitted for severe and worsening dysmenorrhea. Ultrasound examination revealed a rare well-circumscribed cystic lesion about 5.5 × 4 × 5.0 cm. CA-125 level was slightly elevated. She accepted laparoscopic surgery and the adenomyotic tissues were excised. The histopathology of the specimen demonstrated the endometrial glands in the walls of cysts and an area of extensive hemorrhage can be seen in the inner wall of cyst. The patient made a good recovery after surgery and her symptoms complete resoluted.
Conclusions This is a rare case of a cystic adenomyotic lesion that was treated by laparoscopic surgery.
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Affiliation(s)
- Cheng-Zhi Zhao
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Yubei District, Chongqing, China
| | - Bin Wang
- Department of Pathology, Chongqing Health Center for Women and Children, Longshan Road 120, Yubei District, Chongqing, China
| | - Chun-Yan Zhong
- Department of Ultrasonography, Chongqing Health Center for Women and Children, Longshan Road 120, Yubei District, Chongqing, China
| | - Shen-Tao Lu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Yubei District, Chongqing, China
| | - Li Lei
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Yubei District, Chongqing, China.
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24
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Martin DC, Koninckx PR. Juvenile cystic adenomyomas: acquired adenomyosis variant or congenital Müllerian defects? F S Rep 2021; 2:145. [PMID: 34278344 PMCID: PMC8267390 DOI: 10.1016/j.xfre.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dan C Martin
- Professor Emeritus, School of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, and Institutional Review Board, Virginia Commonwealth University, Richmond, Virginia
| | - Philippe R Koninckx
- Latifa Hospital, Dubai, United Arab Emirates
- Professor Emeritus OBGYN, KU Leuven Belgium, University of Oxford-Hon Consultant, United Kingdom
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Naftalin J, Bean E, Saridogan E, Barton-Smith P, Arora R, Jurkovic D. Imaging in gynecological disease (21): clinical and ultrasound characteristics of accessory cavitated uterine malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:821-828. [PMID: 32770812 DOI: 10.1002/uog.22173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of accessory cavitated uterine malformations (ACUMs). METHODS This was a single-center observational study of consecutive patients diagnosed with an ACUM, who had undergone an ultrasound examination by an experienced ultrasound examiner between January 2013 and May 2019, identified retrospectively from medical records. ACUM was diagnosed when a cavitated lesion with a myometrial mantle and echogenic contents was seen within the anterolateral wall of the myometrium beneath the insertion of the round ligament. In all women, presenting symptoms and clinical history were recorded along with detailed descriptions of the lesions and any concomitant pelvic abnormalities. RESULTS Twenty patients diagnosed with an ACUM were identified. Median age was 29.2 (interquartile range, 25.0-35.8) years. None of the women was premenarchal or postmenopausal. All of the women reported painful periods or pelvic pain and none of them reported subfertility. Twelve of the ACUMs were in the right anterolateral myometrium and eight were in the left anterolateral myometrium. Both a myometrial mantle and a fluid-filled cavity were considered to be defining features on ultrasound. The fluid contained within the cavity was either echogenic with a ground-glass appearance or hyperechoic. All of the lesions were spherical in shape. The Doppler flow seen in the outer rim was not markedly different from that of the surrounding myometrium, and the content of the cavity was avascular on Doppler examination. The mean outer cavity diameter of the ACUMs was 22.8 (95% CI, 20.9-24.8) mm and the mean internal cavity diameter was 14.1 (95% CI, 12.2-16.1) mm. Four women opted for transvaginal ultrasound-guided alcohol sclerotherapy. Surgical excision was carried out in eight cases, and the diagnosis was confirmed on histopathological examination in all of them. CONCLUSIONS ACUMs are a uterine abnormality with a distinct ultrasound appearance, which are associated with dysmenorrhea and chronic pelvic pain. Knowledge of their typical appearance on ultrasound could facilitate early detection and treatment. There are several treatment options for ACUM, ranging from simple analgesia to complete excision. Further prospective and longitudinal studies are required to study the prevalence and natural history of this condition. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Naftalin
- Institute for Women's Heath, University College Hospital, London, UK
| | - E Bean
- Institute for Women's Heath, University College Hospital, London, UK
| | - E Saridogan
- Institute for Women's Heath, University College Hospital, London, UK
| | | | - R Arora
- Department of Cellular Pathology, University College London NHS Trust, London, UK
| | - D Jurkovic
- Institute for Women's Heath, University College Hospital, London, UK
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Ji L, Jin L, Zheng S, Shao M, Cui D, Hu M. Laparoscopically assisted Adenomyomectomy Using the Double/Multiple-Flap Method with Temporary Occlusion of the Bilateral Uterine Artery and Utero-Ovarian Vessels in Comparison with the Double/Multiple-Flap Only Method. Geburtshilfe Frauenheilkd 2021; 81:321-330. [PMID: 33692593 PMCID: PMC7938933 DOI: 10.1055/a-1337-2690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/12/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction
Adenomyomectomy is the most conservative surgical treatment for adenomyosis. However, the surgical efficacy of this treatment and the best approach to use are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using the double/multiple-flap method combined with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels to treat symptomatic adenomyosis.
Patients
We recruited 155 patients with symptomatic adenomyosis and divided them into group A (n = 76) and group B (n = 79), with each group treated using a different surgical approach. All eligible women were informed of the potential complications, benefits, and alternatives of each approach before they were assigned into one of the two groups. In group A, we performed laparoscopic adenomyomectomy with the double/multiple-flap method while in group B, we performed a double/multiple-flap adenomyomectomy combined with temporary occlusion of the bilateral uterine artery and utero-ovarian vessels. Over a 24-month follow-up period, we evaluated operating time, intraoperative blood loss, visual analog scale (VAS) scores, anti-Mullerian hormone levels, uterine volume, and relief of menorrhagia.
Results
There were no significant differences between groups A and B with respect to VAS scores, relief of menorrhagia and uterine volume at 3 months, 6 months, 12 months and 24 months after surgery (p > 0.05). Both groups showed significant improvement of these parameters after surgery compared with preoperative values (p < 0.05). Blood loss in group B was significantly lower than in group A (p < 0.001) while there was no significant difference in operating times (p > 0.05). Levels of AMH did not differ significantly between the groups throughout the follow-up period (p > 0.05).
Conclusion
Laparoscopic adenomyomectomy with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels offers a feasible surgical option to treat symptomatic adenomyoma.
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Affiliation(s)
- Limei Ji
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Lanying Jin
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Shunjie Zheng
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Mingjun Shao
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Dawei Cui
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Min Hu
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
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Pelvic Pain and Adnexal Mass: Be Aware of Accessory and Cavitated Uterine Mass. Case Rep Med 2021; 2021:6649663. [PMID: 33628262 PMCID: PMC7892247 DOI: 10.1155/2021/6649663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/18/2022] Open
Abstract
Accessory and cavitated uterine mass (ACUM) is a rare form of Mullerian anomaly that usually presents in young females with chronic cyclic pelvic pain and/or dysmenorrhea. This clinical entity is often underdiagnosed as it may be mistaken for other differential diagnoses, such as pedunculated myoma or adnexal lesions. Imaging modalities, including ultrasonography and magnetic resonance imaging (MRI), accompanied with relevant and suspicious clinical findings are important tools in making acorrect diagnosis. To date, surgical excision of the mass remains the mainstay of treatment,which provides significant symptom relief. In this study, we present a female adolescent with chronic pelvic pain since menarche who underwent laparotomy with the presumed diagnosis of a left-sided ovarian mass. Retrospective evaluation of pelvic MR images demonstrated that the lesion was in fact an ACUM, which was further confirmed by histopathological examination.
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28
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Arya S, Burks HR. Juvenile cystic adenomyoma, a rare diagnostic challenge: Case Reports and literature review. F S Rep 2021; 2:166-171. [PMID: 34278349 PMCID: PMC8267394 DOI: 10.1016/j.xfre.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Sushila Arya
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Heather R Burks
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Adenomyosis and Infertility-Review of Medical and Surgical Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031235. [PMID: 33573117 PMCID: PMC7908401 DOI: 10.3390/ijerph18031235] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms ’adenomyosis and infertility’ and ’adenomyosis and pregnancy outcomes’, extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin-releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques—ultrasound and MRI—enables the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment mentioned above have not given satisfactory results in women planning pregnancy. For these patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before assisted reproductive techniques can prove beneficial in adenomyosis patients.
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30
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Jha S. Adenomyotic cyst mimicking a congenital Müllerian anomaly: Diagnosis and treatment with laparoscopy. Clin Exp Reprod Med 2021; 48:91-94. [PMID: 33467841 PMCID: PMC7943350 DOI: 10.5653/cerm.2020.03867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022] Open
Abstract
A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder.
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Affiliation(s)
- Sangam Jha
- Department of Obstetrics and Gynecology, AIIMS Patna, Bihar, India
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31
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Merviel P, Lelievre C, Cambier T, Thomas‐Kergastel I, Dupré P. The first ethanol sclerotherapy of an accessory cavitated uterine mass. Clin Case Rep 2021; 9:19-22. [PMID: 33489128 PMCID: PMC7812991 DOI: 10.1002/ccr3.3371] [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: 05/07/2020] [Accepted: 08/29/2020] [Indexed: 11/17/2022] Open
Abstract
Accessory cavitated uterine mass (ACUM) is a very rare, underdiagnosed pathology. It is treated with radical surgery, which results in uterine scarring. Here, we describe the first case of ethanol sclerotherapy of an ACUM, modeled on the treatment of recurring endometrioma. Ethanol sclerotherapy avoids uterine scarring and the secondary risk of uterine rupture and enables the rapid achievement of pregnancy.
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Affiliation(s)
- Philippe Merviel
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
| | - Caroline Lelievre
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
| | - Tatiana Cambier
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
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32
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Abstract
To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[Text Word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. Included articles described: pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. Prevalence estimates range from 20% to 88.8% in symptomatic women (average 30-35%) with most diagnosed between 32-38 years old. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report younger symptomatic women are being diagnosed with adenomyosis based on both magnetic resonance imaging (MRI) and/or transvaginal ultrasound (TVUS). High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. Adenomyosis remains a challenge to identify, assess and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathological and imaging diagnoses to gain deeper understandings of adenomyosis.
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Affiliation(s)
- Keith Isaacson
- Department of OB/GYN Harvard Medical School, Department of MIGS and Infertility, Newton, Massachusetts
| | - Megan Loring
- Department of MIGS and Infertility, Newton Wellesley Hospital, Department of MIGS and Infertility, Newton, Massachusetts
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33
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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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34
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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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35
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Abstract
BACKGROUND Juvenile cystic adenomyoma is a rare condition that is often misdiagnosed as a noncommunicating uterine horn or adnexal mass during adolescence. CASES We describe two patients who presented with dysmenorrhea unresponsive to standard management with oral contraceptives. Both patients were initially misdiagnosed as having endometriotic cysts. Juvenile cystic adenomyoma was suspected on standard pelvic ultrasound scan and subsequent high-resolution three-dimensional ultrasonography. The diagnosis was subsequently confirmed and the lesions successfully treated laparoscopically. CONCLUSION Gynecologists should be aware of the possibility of juvenile cystic adenomyoma in adolescents with dysmenorrhea refractory to medical management. Three-dimensional ultrasonography may provide the resolution necessary to distinguish this rare condition.
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36
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Loring M, Chen TY, Isaacson KB. A Systematic Review of Adenomyosis: It Is Time to Reassess What We Thought We Knew about the Disease. J Minim Invasive Gynecol 2020; 28:644-655. [PMID: 33371949 DOI: 10.1016/j.jmig.2020.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. DATA SOURCES Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[text word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. METHODS OF STUDY SELECTION Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. The included articles described pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. TABULATION, INTEGRATION, AND RESULTS Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. The prevalence estimates range from 20% to 88.8% in women who are symptomatic (average 30%-35%), with most diagnosed between the ages of 32 years and 38 years. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report that younger women who are symptomatic are being diagnosed with adenomyosis on the basis of both magnetic resonance imaging and/or transvaginal ultrasound. High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. CONCLUSION Adenomyosis remains a challenge to identify, assess, and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathologic and imaging diagnoses to gain a deeper understanding of adenomyosis.
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Affiliation(s)
- Megan Loring
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
| | - Tammy Y Chen
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Keith B Isaacson
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
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37
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Panwar A, Davis AA, Lata K, Sharma S, Kriplani A. Laparoscopic Management of Accessory Cavitated Uterine Mass: A Report of Two Cases and Review of Literature. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akshita Panwar
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Amenda Ann Davis
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Kusum Lata
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Seema Sharma
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
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38
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Park JC, Kim DJ. Successful laparoscopic surgery of accessory cavitated uterine mass in young women with severe dysmenorrhea. Yeungnam Univ J Med 2020; 38:235-239. [PMID: 32942350 PMCID: PMC8225500 DOI: 10.12701/yujm.2020.00696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Joon Cheol Park
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Ja Kim
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Kiyak H, Seckin KD, Karakis L, Karacan T, Ozyurek ES, Resit Asoglu M. Decidualized juvenile cystic adenomyoma mimicking a cornual pregnancy. Fertil Steril 2020; 113:463-465. [PMID: 32106998 DOI: 10.1016/j.fertnstert.2019.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To demonstrate the laparoscopic excision technique of a juvenile cystic adenomyoma and show how the decidualization of ectopic endometrial tissue can lead to the misdiagnosis of a focus of ectopic pregnancy. DESIGN Description and step-by-step demonstration of the surgical procedure using a video recording (Canadian Task Force Classification 3). SETTING Teaching and research hospital. PATIENT(S) A 27-year-old gravida 2 parity 1 patient with one previous caesarean delivery presented to the emergency department with symptoms of pelvic pain and delayed menses. Her beta-human chorionic gonadotropin level was 2,161 mIU/mL. On transvaginal ultrasonography the uterine cavity appeared empty without any signs of a gestational sac, and a 42×45 mm heterogeneous mass was observed on the right cornual area. An 18×21 mm cystic area was observed within the mass. A diagnosis of cornual pregnancy was made and two doses of systemic methotrexate treatment were administered. On the 12th day following medical treatment, the patient reported increasing abdominal pain and free fluid was observed in the pouch of Douglas on ultrasonography. The decision to perform laparoscopic cornual excision was made. MAIN OUTCOMES AND MEASURE(S) On laparoscopic exploration a tubal ectopic pregnancy was observed within the left fallopian tube. The presence of two simultaneous ectopic pregnancies, located in the left fallopian tube and the right cornual area, was suspected. However, upon careful inspection, the right fallopian tube appeared normal and the mass initially thought to be a right cornual pregnancy appeared more like a degenerated fibroid. A left salpingectomy was performed and the excision of the mass in the right cornual area was planned. An incision was made over the mass and the cystic inner area containing chocolate-brown colored fluid was drained. As there was no pseudo capsule surrounding the mass, the diagnosis of focal adenomyosis instead of degenerated fibroid was made. No endometriotic foci were observed within the pelvis. Different from the enucleation of a fibroid, the mass was dissected from the middle into two halves until healthy myometrium was reached on the floor of the mass. The two halves of the mass were resected totally by dissecting the adenomyotic tissue from the myometrium starting from the caudal end towards the cranial end. The first layer of the remaining myometrial defect was sutured extracorporeally with No.1 polyglactan sutures. The second and third layers were sutured intracorporeally with V-loc sutures. The resected left fallopian tube containing the ectopic pregnancy and the adenomyotic mass were externalized through a posterior colpotomy incision. RESULT(S) The patient was discharged 24 hours postoperatively without any complications. A diagnosis of juvenile cystic adenoma was made upon histopathological examination. The patient reported subsiding of her dysmenorrhea on the postoperative third month. CONCLUSION(S) Juvenile cystic adenomyosis (JCA), is a rare form of focal adenomyosis which is usually located in close proximity to the uterine insertion of the round ligament, contains a cystic inner area larger than 1 cm and is encountered before the age of 30 years. Some authors reported JCA to be an accessory and cavitated uterine mass (ACUM) anomaly developing as a result of gubernaculum dysfunction. The only difference between the two conditions is reported to be the presence of a denser area of adenomyosis surrounding the cystic area lined with endometrium in JCA than in ACUM. This case has shown that decidual changes observed in ectopic endometrial tissue within an adenomyotic area may be misdiagnosed as a focus of ectopic pregnancy. Atypical endometriomas demonstrating decidual changes may also be misdiagnosed as ovarian malignancies. In non-emergency situations, waiting for the decidualization effect of ectopic endometrium to subside can help in the definitive diagnosis of such cases. Our technique for JCA excision is different from enucleation of a fibroid and may aid in the total resection and dissection of the adenomyotic tissue from healthy myometrium.
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Affiliation(s)
- Huseyin Kiyak
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kerem Doga Seckin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Lale Karakis
- Department of Obstetrics and Gynecology, Bahceci Woman Health Center Reproductive Endocrinology and Infertility, Istanbul, Turkey
| | - Tolga Karacan
- Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Eser Sefik Ozyurek
- Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Resit Asoglu
- Department of Obstetrics and Gynecology, Bahceci Woman Health Center Reproductive Endocrinology and Infertility, Istanbul, Turkey
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Chua HA, Goh SC, Upamali V, Seet MJ, Wong PA, Phoon WJ. Subserosal adenomyotic cysts and peritoneal inclusion cysts - Unusual differential diagnoses of multicystic pelvic masses: A review of two cases. Case Rep Womens Health 2020; 27:e00193. [PMID: 32292709 PMCID: PMC7150504 DOI: 10.1016/j.crwh.2020.e00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/15/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
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. Adenomyotic cysts can present as multiple cystic lesions found within the uterine myometrium, submucosal or subserosal layers, lined with endometrial epithelium and stroma. Patients with adenomyotic cysts commonly present with dysmenorrhoea or dysfunctional uterine bleeding. These cysts are usually excised surgically or treated with hormonal methods. 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 Surgical excision of the peritoneal inclusion cysts is the most common treatment option, often for histological diagnosis as it mimics malignancy. Recurrence is common for both conditions, hence long term follow ups with imaging should be considered.
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Deblaere L, Froyman W, Van den Bosch T, Van Rompuy A, Kaijser J, Deprest J, Timmerman D. Juvenile cystic adenomyosis: A case report and review of the literature. Australas J Ultrasound Med 2019; 22:295-300. [PMID: 34760572 PMCID: PMC8411678 DOI: 10.1002/ajum.12171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/02/2019] [Indexed: 09/14/2023] Open
Abstract
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.
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Affiliation(s)
- Lieselot Deblaere
- Department of Development and RegenerationKU LeuvenHerestraat 49Box 805, 3000LeuvenBelgium
| | - Wouter Froyman
- Department of Development and RegenerationKU LeuvenHerestraat 49Box 805, 3000LeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenHerestraat 493000LeuvenBelgium
| | - Thierry Van den Bosch
- Department of Development and RegenerationKU LeuvenHerestraat 49Box 805, 3000LeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenHerestraat 493000LeuvenBelgium
- Department of Obstetrics and GynaecologyRZ Heilig HartKliniekstraat 453300TienenBelgium
| | | | - Jeroen Kaijser
- Department of Obstetrics and GynaecologyIkazia HospitalMontessoriweg 13083AN RotterdamThe Netherlands
| | - Jan Deprest
- Department of Development and RegenerationKU LeuvenHerestraat 49Box 805, 3000LeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenHerestraat 493000LeuvenBelgium
| | - Dirk Timmerman
- Department of Development and RegenerationKU LeuvenHerestraat 49Box 805, 3000LeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenHerestraat 493000LeuvenBelgium
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42
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Strelec M, Banović M, Banović V, Sirovec A. Juvenile cystic adenomyoma mimicking a Mullerian uterine anomaly successfully treated by laparoscopic excision. Int J Gynaecol Obstet 2019; 146:265-266. [PMID: 31179545 DOI: 10.1002/ijgo.12880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/02/2019] [Accepted: 05/20/2019] [Indexed: 11/11/2022]
Abstract
A 14‐year‐old patient diagnosed with a juvenile cystic adenomyoma mimicking a Mullerian uterine anomaly successfully treated by a laparoscopic excision.
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Affiliation(s)
- Mihajlo Strelec
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Maja Banović
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vladimir Banović
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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43
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Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y. Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy. Insights Imaging 2019; 10:48. [PMID: 31030317 PMCID: PMC6486932 DOI: 10.1186/s13244-019-0732-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/14/2019] [Indexed: 12/31/2022] Open
Abstract
Adenomyosis is a challenging clinical condition that is commonly being diagnosed in women of reproductive age. To date, many aspects of the disease have not been fully understood, making management increasingly difficult. Over time, minimally invasive diagnostic and treatment methods have developed as more women desire uterine preservation for future fertility or to avoid major surgery. Several uterine-sparing treatment options are now available, including medication, hysteroscopic resection or ablation, conservative surgical methods, and high-intensity focused ultrasound each with its own risks and benefits. Uterine artery embolization is an established treatment option for uterine fibroids and has recently gained ground as a safe and cost-effective method for treatment of uterine adenomyosis with promising results. In this review, we discuss current trends in the management of uterine adenomyosis with a special focus on uterine artery embolization as an alternative to hysterectomy.
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Affiliation(s)
- Riham Dessouky
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt.
| | - Sherif A Gamil
- Radiology Department, Al-Ahrar Teaching Hospital, Zagazig, Egypt
| | - Mohamad Gamal Nada
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
| | - Rola Mousa
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
| | - Yasmine Libda
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
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44
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Fan YY, Liu YN, Li J, Fu Y. Intrauterine cystic adenomyosis: Report of two cases. World J Clin Cases 2019; 7:676-683. [PMID: 30863769 PMCID: PMC6406199 DOI: 10.12998/wjcc.v7.i5.676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cystic adenomyosis is a special type of adenomyosis. Its clinical manifestations lack specificity. Pelvic ultrasound and nuclear magnetic resonance imaging can help clarify the diagnosis. Because cystic uterine adenomyosis is rare in clinical work, it can be easily misdiagnosed or its diagnosis can be missed. Early surgical treatment and postoperative drug treatment can alleviate dysmenorrhea, menorrhagia, anemia, and other symptoms.
CASE SUMMARY Two cases complained about abnormal vaginal bleeding and were diagnosed with intrauterine cystic adenomyosis by gynecological ultrasound and pathological examination. The clinical manifestations included dysmenorrhea, hypermenorrhea, and a history of cesarean section. Both cases underwent a surgery, and chocolate-like liquid was released from the cystic mass in the uterus and the manifestations were relieved.
CONCLUSION Intrauterine cystic adenomyosis could be diagnosed by pathological examination and treated by hysterectomy or hystscopy to release the liquid inside.
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Affiliation(s)
- Yan-Yan Fan
- Department of Obstetrics and Gynecology, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yi-Nan Liu
- Department of Otorhinolaryngology, Jilin Province FAW General Hospital, Changchun 130011, Jilin Province, China
| | - Jia Li
- Department of Obstetrics and Gynecology, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yan Fu
- Department of Obstetrics and Gynecology, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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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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Yu W, Liu G, Liu C, Zhang Z. Recurrence-associated factors of laparoscopic adenomyomectomy for severely symptomatic adenomyoma. Oncol Lett 2018; 16:3430-3438. [PMID: 30127945 PMCID: PMC6096152 DOI: 10.3892/ol.2018.9082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
The present study aimed to identify which patients with adenomyoma would benefit from sparing the uterus and which patients should undergo a hysterectomy to avoid secondary surgery. Patients with pathology-proven adenomyoma admitted to Beijing Chao-Yang Hospital between November 2005 and November 2015 were retrospectively reviewed. Relief and reappearance of dysmenorrhea following laparoscopic adenomyomectomy were evaluated. All 49 patients (mean age, 40.6±5.2 years; age range, 26-51 years) presented with severe dysmenorrhea prior to surgery. Dysmenorrhea was identified to be relieved in 83.7% (41/49) of patients at the 6-month follow-up. No factors were revealed to have a significant effect on the surgical outcome. The median follow-up period was 4.6 (1-11) years; and 24.5% (12/49) of patients experienced recurrence of dysmenorrhea. Multivariate analysis identified preoperative serum cancer antigen 125 (CA 125) levels [hazard ratio (HR), 2.356; 95% confidence interval (CI), 1.271-3.570; P=0.011], postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment (HR, 0.540; 95% CI, 0.241-0.873; P=0.017) and accompanying endometriosis (HR, 2.182; 95% CI, 1.556-3.031; P=0.003) as independent risk factors for relapse. Laparoscopic adenomyomectomy is effective for alleviating dysmenorrhea in patients with adenomyoma. Patients with lower preoperative serum CA 125 levels without accompanying endometriosis benefited greater from adenomyomectomy compared with all other patients. Postoperative GnRH-a treatment strengthens therapeutic effects.
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Affiliation(s)
- Wentao Yu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 10020, P.R. China.,Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Guanyuan Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 10020, P.R. China
| | - Chongdong Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 10020, P.R. China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 10020, P.R. China
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Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, Bedaiwy MA. Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: A Systematic Review. J Minim Invasive Gynecol 2018; 25:608-621. [DOI: 10.1016/j.jmig.2017.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/02/2017] [Accepted: 12/23/2017] [Indexed: 01/10/2023]
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48
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The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6832685. [PMID: 29736395 PMCID: PMC5875064 DOI: 10.1155/2018/6832685] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/18/2018] [Indexed: 12/14/2022]
Abstract
The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.
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Bazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril 2018; 109:389-397. [DOI: 10.1016/j.fertnstert.2018.01.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
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50
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Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2018; 51:119-137. [PMID: 29555380 DOI: 10.1016/j.bpobgyn.2018.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 12/15/2022]
Abstract
The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD). A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE). This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.
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Affiliation(s)
- Margit Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juhl Jensensvej 100, 8200 Aarhus N, Denmark.
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