Case Series: Minimally Invasive Management of Juvenile Cystic Adenomyoma

Abstract

Study Objective To increase awareness of juvenile cystic adenomyoma (JCA) in patients with chronic pelvic pain. Design Retrospective case series. Setting Teaching hospital. Patients or Participants Three patients aged 16-30 years old presented with chronic pelvic pain (CPP) [2016 - 2019]. Hormonal treatment was attempted in two cases, but it failed. Cystic lesions in the myometrium (n=2), and the broad ligament (n=1) was detected on transvaginal 2D ultrasound (TV 2D US) and/ or MRI. The cyst was separated from the endometrial cavity in all the cases. The cysts were within the myometrium of the posterior wall of the uterus, within the cornual region of the myometrium and within the broad ligament near the cornual region in the three cases respectively. Interventions Laparoscopic excision of the lesions. Measurements and Main Results 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 (a video to be presented). Robotic assistance was chosen in one case as the cyst was in the broad ligament, for better visualization. The endometrial cavity was entered in one case (0.5cm). Pathology report confirmed the diagnosis of JCA is all cases. All three patients reported relief of their symptoms up to 6 to 8 months after surgery. No recurrence of the JCA was reported using TV 2D US in all cases. Conclusion JCA represents a rare focal form of adenomyosis that may affect young women. Large cystic lesions, as isolate entities within the uterus were reported to be rare; less than 1%. The exact mechanism is largely unknown. Our data suggest that minimally invasive surgery for excision of the cyst is the chosen approach of management. Our data also suggest symptomatic relief with no sonographic evidence of recurrence following surgery.