MRI of adenomyotic cyst of the uterus

Spontaneous rupture of a uterine leiomyoma accompanied by a hematoma appearing as a cystic lesion on imaging: A case report

The rupture of a uterine leiomyoma is a rare complication. We report a case of ruptured leiomyoma that formed a hematoma that was initially suggestive of an ovarian origin. Magnetic resonance imaging revealed intact ovaries and a cystic lesion adjacent to leiomyomas. During surgery, the cystic lesion was found to be a hematoma caused by a rupture of the leiomyoma.

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

Background

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

Case Presentation

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

Conclusion

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

MR findings of uterine PEComa in patients with tuberous sclerosis: report of two cases

Tuberous sclerosis complex (TSC), a rare autosomal dominant neurocutaneous disorder, is characterized by the presence of benign congenital tumors in multiple organs. Neoplasms with perivascular epithelioid cell differentiation (PEComas), including angiomyolipoma (AML) and lymphangioleiomyomatosis (LAM), can occur in association with TSC. This report describes two cases of uterine PEComas presenting characteristic MR imaging features reflecting pathological findings. From MR images, both cases showed single or multiple large, irregularly shaped or lobulated hemorrhagic lesions within the myometrium. They differed from typical adenomyotic cysts in their large size and irregular margins. Histopathologic analysis revealed that the hemorrhage was caused by adenomyosis and tumor cells that proliferated in surrounding stroma of the hemorrhagic lesions, compatible with PEComas. Microscopic observation revealed an infiltrative growth pattern of PEComas, with small nodules formed. The tumor lesions, however, were difficult to detect on MR images. The myometrium showed normal appearance on both T1-weighted and T2-weighted images in both cases. We speculate that PEComas may infiltrate extensively into the myometrium even when the myometrium shows almost normal radiologic appearance.

Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity

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.

Uterine Cystic Adenomyosis: A Disease of Younger Women

PURPOSE OF REVIEW

We adopted a life-cycle approach to further our understanding of the natural history of the cystic forms of uterine adenomyosis first described by Cullen in 1908.

SEARCH STRATEGY

Scopus and PubMed were searched for all terms referring to cystic variant of adenomyosis or adenomyoma. References found in major publications were also included in the review.

MAIN FINDINGS

With the introduction of non-invasive imaging techniques, a number of cases of cystic variants of adenomyosis have been reported. Progressive, severe, medication-resistant dysmenorrhea is the main clinical feature but delay in diagnosis remains problematic. The life-cycle approach demonstrates that cystic adenomyosis is more relevant to adolescent and young adulthood. Congenital müllerian and wolffian cysts and the uterus-like masses are more frequent in women >30 years of age. The latter is frequently located outside the uterus and may represent a form of endometriosis rather than adenomyosis. Differential diagnosis includes ovarian cysts and congenital uterine anomalies. Menstruation suppression with continuous oral contraceptive pill with ultrasonographic monitoring of cyst regression may prove successful in the young woman, but surgical excision using minimally invasive endoscopy is highly effective. The various terms used in literature to describe these lesions cause considerable confusion. Here we propose a classification into 3 subtypes and standardized reporting criteria to enable comparison.

CONCLUSIONS

Endometrial lined myometrial cysts are almost specific to adolescent and young women. We propose a new classification system.

Endosonography of benign myometrium cysts and cyst-like lesions

INTRODUCTION

Many pathological causes are responsible for the sonographic presentation of myometrium cysts and cyst-like lesions, where the distinction between these etiologies is required.

THE AIM OF THE WORK

The current work is aimed at discerning between different etiologies of myometrium cysts and cyst-like lesions for an optimum management.

METHODOLOGY

In the course of daily practice of gynecological transvaginal ultrasound, 66 cases of myometrium cysts and cyst-like lesions have been discerned, where all were examined with endovaginal ultrasound using a multifrequency endocavitary probe having color Doppler capability.

RESULTS

Adenomyosis uteri detected in 15 cases, invasive mole in 4 cases, congested arcuate veins in 20 cases, incidental cysts in 4 cases, cystic degeneration of myoma in 3 cases, C-section scar cysts and cyst-like lesions in 13 cases, interstitial ectopic pregnancy in 2 cases, incomplete abortion with congested myometrium vessels in 4 cases, and arteriovenous malformation in 1 case. The number of cases with cervical nabothian cysts was not considered since they were too frequent.

CONCLUSION

Endosonography is an important tool in differentiating between the various diseases that are responsible for benign myometrium cysts and cyst-like lesions, which are all important since some of them are visualized as serious clinical situations and others turn out to be of little clinical significance.

Cystic adenomyosis spreading into subserosal-peduncolated myoma: How to explain it?

Introduction

Cystic adenomyosis is a rare variant of adenomyosis characterized by well- circumscribed cavitated endometrial gland and stroma located within the myometrium. The cysts usually measure ≥ 1 cm in diameter, contain a “chocolate-colored” fluid and do not open into the overlaying endometrium.

Case presentation

We present a case of a peduncolated-subserosal cystic adenomyoma, namely cystic adenomyosis, correlated with pelvic MR imaging, laparoscopic surgery technique and histopathology findings.

Conclusions

In this case, the peculiar growth pattern of cystic adenomyosis in a myoma represents a singular condition rarely reported in the medical literature. We therefore support the pathogenetic theory that the disease might have been caused by direct proliferation of endometrial cells within a peduncolated- subserosal myoma.

Cystic Adenomyoma simulates uterine malformation: A diagnostic dilemma: Case report of two unusual cases

Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women.We report two cases of cystic adenomyosis in juvenile patients, which simulate uterine malformation and presented as a diagnostic dilemma. The first patient initially was diagnosed as uterus bicornis with a hematometra in obstructed rudimentary horn while the second patient was diagnosed as broad ligament fibroid. Surgical exploration by laparoscopic approach confirmed the diagnosis and excision of the cystic mass relieved the symptoms of the patients.

Juvenile cystic adenomyoma

The purpose of this paper is to describe a case of juvenile cystic adenomyoma in a 17 year-old female patient with severe dysmenorrhoea unresponsive to non-steroidal anti-inflammatory drugs. The patient presents progressively worsening dysmenorrhoea that started 2 years after menarche and a cystic uterine lesion in MRI. The cyclic nature of symptoms, the similarity of the lesion and endometrium in MRI signal intensity and response to hormone suppression are consistent with juvenile cystic adenomyoma. The treatment depends on the age of the patient, severity of her symptoms and size and localisation of the cyst. This is a rare condition in young nulliparous women with a challenging differential diagnosis. This case highlights the relevance of MRI in the patient's study, featuring important characteristics of the lesion that disclosed the final diagnosis.

Unusual manifestation of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis of the uterus: emphasis on MRI and positron emission tomography CT findings

There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.

The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus

OBJECTIVE

To present clinical cases of women who had an accessory and cavitated noncommunicating uterine mass with functioning endometrium associated with a normal uterus, suggestive of a new type of Müllerian anomaly.

METHODS

We report on five institutional cases: four cases of cavitated accessory uterine mass and a case of true adenomyoma. A review of the literature was performed by looking for these terms and others related in MEDLINE.

RESULTS

Including ours, there are 18 cases in the literature showing an accessory cystic cavity lined by endometrioid epithelium with an otherwise normal uterus. Another 11 cases only partially fulfilled the inclusion criteria. All of the first cases were in young women presenting with severe dysmenorrhea (n=4). Generally, the tumor was located in the anterior wall of the uterus at the level of insertion of the round ligament. It presents a certain similarity with the cavitated true adenomyomas observed in older women in whom the endometrial lining of the cystic cavity is generally absent. For differential diagnosis with cavitated noncommunicating rudimentary uterine horns, hysterosalpingography showing a normal eutopic uterine cavity is decisive.

CONCLUSION

Noncommunicating accessory uterine cavities and isolated cystic adenomyomas correspond to the same pathology: cavitated accessory uterine mass associated with an otherwise normal uterus. They present problems of differential diagnosis with true cavitated adenomyomas and cavitated rudimentary uterine horns. Accessory uterine mass could be caused by duplication and persistence of ductal Müllerian tissue in a critical area at the attachment level of the round ligament, possibly related to a gubernaculum dysfunction.

LEVEL OF EVIDENCE

III.

Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images: report of three cases and literature review

Endometrial stromal sarcoma (ESS) most commonly grows from the uterine endometrium into the endometrial cavity; it is rarely located in the myometrium alone, where it may resemble degenerated leiomyoma on magnetic resonance imaging (MRI). We present three cases of intramyometrial ESS mimicking degenerated leiomyoma, all of which have a characteristic low-intensity rim on T2-weighted images. Histopathological examination revealed the rim to consist of fibrous tissue layers and/or a decrease in free water caused by distortion of myometrial tissue following tumor expansion. ESS should be included in the differential diagnosis of intramyometrial mass with low-intensity rim on T2-weighted image, especially if the mass shows degeneration with no or mild intratumoral hemorrhage.

Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases

OBJECTIVE

To define diagnostic criteria for juvenile cystic adenomyoma (JCA), describe the histologic features of the condition and evaluate laparoscopic excision for treating associated dysmenorrhea and pelvic pain.

DESIGN

Prospective long-term follow-up study.

SETTING

University-affiliated hospital.

PATIENT(S)

Nine consecutive patients with JCA.

INTERVENTION(S)

Patients meeting the diagnostic criteria for JCA underwent laparoscopic enucleation of the lesion. The severity of dysmenorrhea was evaluated before surgery and every 6 months after surgery. Five patients underwent second-look laparoscopy (SLL) 6 months after surgery.

MAIN OUTCOME MEASURE(S)

Relief of dysmenorrhea as measured by a visual analog scale, postoperative healing at SLL, and subsequent pregnancy when desired by the patient.

RESULT(S)

Laparoscopic enucleation of the cystic adenomyoma resulted in a statistically and clinically significant reduction in dysmenorrhea and improved chronic pelvic pain. Neither cystic adenomyoma nor severe dysmenorrhea recurred during the follow-up period. Adhesions were minimal at SLL. Two of the three patients who desired pregnancy conceived after surgery. The histologic findings of the JCA lesion and adenomyosis were similar, and the endometrial glands and stroma infiltrating the surrounding myometrium in all patients were consistent with the appearance of adenomyosis.

CONCLUSION(S)

We defined the diagnostic criteria for JCA, and demonstrated significant improvement of dysmenorrhea after laparoscopic excision of the lesion.

Adenomyotic cyst in an adolescent girl

BACKGROUND

Cystic adenomyosis is an extremely rare form of adenomyosis, particularly in the pediatric population. We report a unique case of an adenomyotic cyst in an adolescent girl.

CASE

A 16-year-old G0P0 presented with cyclic pelvic pain. Ultrasonography demonstrated a large cystic lesion, which was localized to the myometrium on computed tomography and magnetic resonance imaging. The lesion was surgically excised and confirmed to be cystic adenomyosis by pathology.

SUMMARY AND CONCLUSION

Cystic adenomyosis is a rare cause of abdominopelvic pain and dysmenorrhea in adolescents. Imaging is key in distinguishing this disease from other congenital and acquired gynecological disorders. Awareness of this condition is important for timely, accurate diagnosis and intervention.

Adenomyotic cyst of the uterus in an adolescent

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not previously been reported in the pediatric radiology literature. In this case report, we describe an adenomyotic cyst in an adolescent girl that was imaged with US, CT, and MR and proved by surgical pathology. Understanding of the radiologic features of cystic adenomyosis is important for noninvasive diagnosis and effective medical/surgical management.

Myometrial involvement of tumor-like cystic endosalpingiosis: a rare entity

Endosalpingiosis is characterized by the presence of benign glands lined by tubal-type epithelium involving the pelvic and lower abdominal peritoneum and pelvic and para-aortic lymph nodes in women. Rarely, cystification can occur, resulting in a neoplasm-like mass associated with clinical manifestations, an intraoperative abnormality, or a striking finding on gross examination. Here we report the transvaginal ultrasound, magnetic resonance imaging and histopathological appearance of an unusual case of cystic endosalpingiosis involving the right ovary and full thickness of the wall of the uterine fundus in a patient who presented with a 6-month history of menorrhagia and pelvic pain. Clinicians should be aware of this type of uterine benign manifestation so as to refrain from overtreatment.

Isolated adenomyotic cyst associated with severe dysmenorrhea

A case of a 23-year-old, nulliparous female with a very rare isolated adenomyotic cyst inducing severe dysmenorrhea was seen. Transvaginal ultrasonographic tomography and magnetic resonance imaging (MRI) showed a 3 x 3-cm cystic mass within the left anterior wall of the uterine corpus. The cystic space was filled with hyperintense fluid on T1-weighted images, which was surrounded by hypointense tissue beside the right uterine corpus on T2-weighted images. The case was preliminarily diagnosed using MRI as having cavitated rudimentary uterine horn. However, hysterosalpingography excluded the possibility of uterine anomaly. A hemorrhagic adenomyotic cyst measuring 3 cm within the left anterior wall of the uterine corpus was surgically removed. There was no evidence of diffuse adenomyosis uteri. Dysmenorrhea completely disappeared postoperatively.

Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage

A case of single large cystic adenomyoma of the uterus (anechoic area 1.6 cm in diameter) was diagnosed by surgery and histopathologic analysis more than 3 years after a transcervical curettage for an early right-cornual pregnancy.

Laparoscopic management of juvenile cystic adenomyoma of the uterus: Report of two cases and review of the literature

Two cases of juvenile cystic adenomyoma of the uterus treated by laparoscopic surgery are reported. Preoperative diagnostic imaging procedures located a cystic structure within the uterine nodule of each of these young women with severe dysmenorrhea. Under a diagnosis of cystic adenomyoma, laparoscopic excision was performed. Histopathologic examination of the resected tissues showed the presence of an endometrial structure composed of epithelium and stroma within myometrial nodule. In both of these patients, dysmenorrhea disappeared postoperatively.

Huge uterine leiomyoma with adenomyotic cysts mimicking uterine sarcoma on MR imaging

Magnetic resonance imaging of a 39-year-old woman who presented with an abdominal mass revealed a tumor with hemorrhagic lesions extending from the intrauterine space to the subserosa. Hysterectomy was performed for probable uterine sarcoma. The histological examination diagnosed uterine leiomyoma with severe myxoid degeneration and without malignant components. Hemorrhagic lesions were diagnosed as adenomyotic cysts, resulting in findings similar to those of a uterine sarcoma.

Cystic myometrial lesion in the uterus of an adolescent girl

The clinical course and radiographic appearance of a cystic myometrial lesion in a 13-year-old adolescent girl are described. Hormone suppression with continuous oral contraceptive (OC) pills resulted in partial regression of the lesion, as well as control of symptoms.

Spectrum of MR features in adenomyosis

Magnetic resonance (MR) imaging is a highly accurate non-invasive technique for the diagnosis of adenomyosis. Typical MR features include either diffuse or focal thickening of the junctional zone or an ill-defined area of low signal intensity in the myometrium on T2-weighted MR images. Occasionally, the islands of ectopic endometrial tissue can be identified as punctate foci of high signal intensity. Less commonly, adenomyosis can present as a well-circumscribed form known as adenomyoma, adenomyotic cyst characterized by the presence of haemorrhagic cyst, or adenomyomatous polyp protruding into the uterine cavity. The MR appearances of adenomyosis may occasionally fluctuate in response to hormonal stimulation and treatment. MR imaging is helpful not only in monitoring the treatment effect of hormonal therapy, but also in predicting therapeutic effect. In cases of endometrial cancer in the uterus with adenomyosis, evaluation of myometrial invasion may become difficult. Rarely, endometrial cancer may arise directly from adenomyosis resulting from malignant transformation of endometrial glands, creating diagnostic challenges. Differential diagnosis of adenomyosis on MR imaging include physiological myometrial contraction and almost all myometrial lesions, and they should be carefully differentiated from adenomyosis by identifying typical clinical and MR features in these lesions. Precise knowledge of the spectrum of MR features in adenomyosis greatly helps in determining an accurate diagnosis and appropriate management of the patients.

Adenomyosis:common and uncommon manifestations on sonography and magnetic resonance imaging

OBJECTIVE

The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI).

METHODS

A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed.

RESULTS

Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases.

CONCLUSIONS

Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.

[Adenomyosis: update on a frequent but difficult diagnosis]

Adenomyosis is a frequent entity, with difficult diagnosis, often obtained by pathological analysis performed after hysterectomy. This condition can cause abnormal uterine bleeding and dysmenorrhea, frequent reasons for consultation and hysterectomy. The development of ultrasonographic and magnetic resonance imaging techniques allow preoperative diagnosis. They also permit the use of hysteroscopic techniques for conservative uterine surgery, and have brought diagnosis and management of this disease to the front of the scene. This article reviews the pathological description of the disease, its epidemiology, clinical presentations, useful and necessary explorations, etiopathogeny and available therapies.

Cystic adenomyosis with florid glandular differentiation mimicking ovarian malignancy

We report a case of cystic adenomyosis, presenting as a huge exophytic cystic mass with florid glandular differentiation. MR findings of the mass mimicked ovarian carcinoma associated with endometriosis. The presence of signal voids bridging the uterus and tumour should suggest a mass of uterine origin. Hyperintense protuberance in a hypointense loculus on T(2) weighted images may suggest benign disease. However, surgical exploration and resection is still required to exclude an ovarian malignancy.

MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls

Adenomyosis is a nonneoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with hyperplasia of adjacent smooth muscle. The common symptoms include dysmenorrhea, menorrhagia, and abnormal uterine bleeding, but these do not allow diagnosis. Therefore, imaging plays an important role because establishment of the correct preoperative diagnosis is critical to avoid unnecessary intervention. Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis of adenomyosis, differentiation of adenomyosis from other gynecologic disorders, and planning of appropriate treatment. Although the typical MR imaging findings are well established, adenomyosis actually varies widely in terms of histopathologic features (adenomyosis with sparse glands), growth patterns (polypoid adenomyoma, adenomyotic cyst, and miniature uterus), responses to hormonal activity (tamoxifen, decidual changes), and responses to treatment (gonadotropin-releasing hormone agonist). The MR imaging findings of adenomyosis occasionally mimic those of uterine malignancy or ovarian cancer. Furthermore, malignancy occasionally develops in otherwise benign adenomyosis. Pitfalls in diagnosis of adenomyosis include myometrial contractions, leiomyoma, adenomatoid tumor, metastases, endometrial carcinoma, and endometrial stromal sarcoma. Knowledge of the various appearances of adenomyosis and the possible pitfalls in differential diagnosis help guide the determination of appropriate treatment options.

Determinants of MR relaxation rates in jaw cysts: implications for diagnostic values of the relaxation times

OBJECTIVES

The MRI signal intensities and the relaxation times (T1 and T2) have already been used for comparisons among various types of cysts. The signal intensities (or T1 and T2) were suggested to be related to cyst content. However, such a relationship between the relaxation rates (1/T1 and 1/T2) and the aspirated content of jaw cysts was not given. Therefore, an investigation on the determinants of the relaxation rates in the jaw cysts may be helpful in elucidating the biological basis for the differences in relaxation rates among the categories of jaw cysts.

METHODS

The aspirated contents of 23 cysts (16 radicular and 7 haemorrhagic) were scanned using an MR imager operating at 1 T magnetic field strength. The viscosities and the dry-weight-to-water-weight ratios (Ms/Mw) were determined. Also, the mean values of cyst categories were compared using statistical analysis.

RESULTS

The 1/T1 had a moderate correlation with viscosity (0.66) and Ms/Mw (0.56), while the 1/T2 had a good correlation with viscosity (0.87) and Ms/Mw (0.82). The mean values of viscosity, Ms/Mw and relaxation rates in radicular cysts were significantly lower (P < 0.05) than those of haemorrhagic cysts.

CONCLUSIONS

The present data suggest that similarities and differences between relaxation rates of radicular and haemorrhagic cysts can be explained by the solid content and viscosity of cysts.

Embolization of uterine fibroids

Since the first description of uterine artery embolization for the treatment of symptomatic fibroids of the uterus in 1994, this minimally invasive procedure has been increasingly performed in many Western countries. The method is characterized by a high technical success rate of about 85%, a highly significant relief of symptoms, and a very low rate of complications that make this method an appealing alternative to classic treatment options of surgical or laparoscopic myomectomy or hysterectomy. These characteristics have made the procedure well accepted by affected women. Nevertheless, indications and potential contraindications have to be evaluated carefully, especially in patients of childbearing age whenever a considerable number of deliveries is reported after uterine fibroid embolization. This article discusses the clinical background, indications and contraindications, angiographic techniques, potential complications and side effects, and the mid-term results known at present.

Total laparoscopic surgery of cystic adenomyoma under hydroultrasonographic monitoring

A 19-year-old-woman had a cystic adenomyoma located within the myometrium. She complained of severe dysmenorrhea. Gonadotropin-releasing hormone agonist therapy was administered, but her dysmenorrhea was more pronounced than before treatment. Therefore, total laparoscopic resection of the lesion was performed. The external appearance of the patient's uterus was almost normal. A hydroultrasonographic monitoring method was devised (transvaginal ultrasonography with peritoneal hydration of physiologic saline) that proved useful in locating the adenomyoma. The patient's dysmenorrhea disappeared postoperatively.