Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis.

S. Gordts,R. Campo,I. Brosens

doi:10.1007/s10397-014-0861-5

S. Gordts, R. Campo + Show 1 more

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https://doi.org/10.1007/s10397-014-0861-5

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Abstract

In 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmenorrhea, chronic pelvic pain, and dysfunctional uterine bleeding. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treatment is increasing. Therefore, in these patients, uterine exploration should include not only the evaluation of the endometrial cavity but also the exploration of the sub-endometrial zone. Indirect imaging techniques, combined with office mini-hysteroscopy, offer the possibility of complete uterine exploration. Two patients with cystic adenomyosis are described in this paper: one had the chief complaint of menorrhagia and the other was referred for evaluation of infertility and severe dysmenorrhea. The aim of these case reports is to present hysteroscopic dissection and ablation of adenomyotic cysts as an alternative procedure for the surgical management of this condition.

Highlights

The uterine adenomyotic cyst is a cystic structure lined with endometrial tissue and surrounded by myometrial tissue that, in most cases, contains hemorrhagic material
The present cases illustrate the possibility of hysteroscopy for diagnosis and resection or ablation of intramural cystic adenomyosis
Diagnostic hysteroscopy does not reveal the pathognomonic signs of adenomyosis, some studies suggests that an irregular endometrium with endometrial defects, altered vascularization, and cystic hemorrhagic lesion are possibly associated with adenomyosis [9]

Summary

Introduction

The uterine adenomyotic cyst is a cystic structure lined with endometrial tissue and surrounded by myometrial tissue that, in most cases, contains hemorrhagic material. Cullen [1] described the first cases in 1908 in his textbook on adenomyomata, in which he distinguished submucosal and subperitoneal cystic adenomyomata. The clinical symptoms are nonspecific and include dysmenorrhea starting at an early age around the time of menarche, chronic pelvic pain, and dysfunctional uterine bleeding. The dysmenorrhea tends to progressively increase and is resistant to therapy with analgesics or cyclic oral contraceptives. The cyst increases in size at the time of menstruation and hormonal suppression with continuous oral contraceptive pills results in a partial regression [3]

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