Adenomyotic Cyst Research Articles

Two Methods for Adenomyotic Cyst Excision

<h3>Study Objective</h3> The objective of this video is to demonstrate two techniques for hysteroscopic resection of adenomyotic cysts. <h3>Design</h3> N/A. <h3>Setting</h3> A patient desiring fertility presents for further evaluation. Imaging is notable for two fundal cysts on ultrasound consistent with adenomyosis. After informed consent is obtained, OR hysteroscopy is performed under ultrasound guidance. <h3>Patients or Participants</h3> One patient with adenomyotic cysts is highlighted. <h3>Interventions</h3> The patient is taken to the operating room and a 5.5mm rigid hysteroscope is advanced to the fundus under ultrasound guidance. After confirming the location of adenomyotic cysts via ultrasound, hysteroscopic scissors are used to open the cysts, with adenomyosis confirmed by release of chocolate brown fluid. Cyst walls are resected in their entirety, one sharply and one with bipolar loop. <h3>Measurements and Main Results</h3> Direct visualization of the endometrial cavity as well as intraoperative ultrasound confirm complete removal of adenomyotic cysts. Pathology of the cyst walls confirmed adenomyosis. <h3>Conclusion</h3> Hysteroscopic resection of adenomyosis is safe and effective in select patients with focal disease, allowing for targeted removal under direct visualization. Here we demonstrate two hysteroscopic techniques for resection of adenomyotic cyst wall: sharp dissection, and the bipolar loop electrode.

Laparoscopic Management of a Juvenile Cystic Adenomyoma

<h3>Study Objective</h3> To demonstrate how to diagnose and surgically manage an adenomyotic cyst by a robotic assisted laparoscopic approach. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Operating theatre. <h3>Patients or Participants</h3> A 17-year-old patient with acute pelvic pain in the setting of chronic dysmenorrhea associated with a 4 cm cystic lesion in the endometrium on MRI consistent with a juvenile cystic adenomyoma. After no improvement with hormonal management, the patient opted for laparoscopic exploration and removal. <h3>Interventions</h3> MRI imaging was used to identify the adenomyotic cyst. Upon laparoscopy, the surgical site was injected with vasopressin for hemostasis. Sharp and blunt dissection was used to minimize trauma and thermal injury to the surrounding myometrium. Chromopertubation was used verify no cavity entry after removal. Lastly, the myometrium was closed in multiple layers to prevent hematoma formation. <h3>Measurements and Main Results</h3> Successful outpatient procedure with improved pain post-operatively. <h3>Conclusion</h3> This video shows techniques to identify and perform a minimally invasive fertility preserving resection of a juvenile cystic adenomyoma.

Adenomyotic Cyst at Menopause Transition: A Combined Treatment

Cystic adenomyosis is a progressive, severe disease that causes medical resistant dysmenorrhea with a delay in diagnosis [1]. A 52-year-old woman presented to our clinic with a complaint of severe dysmenorrhea, an 8 on the visual analog score of pain, persisting for 1 year. Her previous menstrual cycles were regular and pain-free. There was no response to the oral progesterone therapy that she had for 6 months.

Hysteroscopic Management of Cystic Adenomyosis

Video Objective To demonstrate a case of cystic adenomyosis treated by hysteroscopic intervention and the course of the lesion thereafter. Setting The patient is a 42 years old, G3 P1 woman complaining of heavy menstrual bleeding of 6 months duration with concomitant severe dysmenorrhea. Ultrasound examination revealed a 32 × 30 mm cystic mass in the anterior uterine wall at the junctional zone. Interventions Following hysteroscopic resection with a wire loop resectoscope and rollerball coagulation of the inner surface of the adenomyotic cyst, there was complete disappearance of the anterior myometrial defect and resolution of symptoms 4 months after the surgery. Conclusion Symptomatic cystic adenomyosis on the junctional zone can be managed by hysteroscopic resection. Following creation of an opening on the cyst wall, internal surfaces may be treated with rollerball coagulation. Healing appears complete with no residual dead space on the junctional zone.

Resection of Cystic Adenomyosis

Video Objective To describe a case of cystic adenomyosis and demonstrate the resection of adenomyotic cysts. Setting A 21 year-old nulligravid patient presents for worsening chronic pelvic pain for 3-4 years which is only partially responsive to oral contraceptives. Interventions Ultrasound and MRI images confirmed the diagnosis of cystic adenomyosis, and the patient underwent robotic-assisted laparoscopic resection and removal of cystic adenomyosis. Conclusion Cystic adenomyosis is a rare disorder that requires excision for complete resolution of symptoms. It is necessary to have a high index of suspicion in young patients with dysmenorrhea that does not resolve with hormonal therapy. It is also important for gynecologists to review ultrasound and MRI images themselves and in conjunction with radiologists experienced in pelvic imaging to reduce misdiagnosis.

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.

Hysteroscopic management of a juvenile cystic adenomyosis

Introduction: Hysteroscopic management of juvenile cystic adenomyosis on a virgin patient with non-touch technique. Description: Juvenile cystic adenomyosis of uterus is a cyst which is surrounded by myometrium and inside of this cyst is filled with hemorrhagic fluid. A 23-year-old virgin patient admitted to endometriosis outpatient clinic. The patient complained of dysmenorrhea, chronic pelvic pain, and abnormal uterine bleeding. A submucosal adenomyotic cyst was, sized 40 mm approximately, determined at posterior wall of uterus by transrectal ultrasonography. She received daily 2 mg dienogest (Visanne®) for 6 months. At the end of 6 months of treatment, the cyst size was still 35 mm. Hysteroscopy was performed with the use of the non-touch technique (vaginoscopic approach). A rigid 2.9-mm hysteroscope with a 12° oblique lens and an outer sheath diameter of 4 mm was used. When the cystic wall was ruptured by bipolar instrument, a chocolate-colored fluid was drained. The operation lasted 10 min. Her postoperative course was uncomplicated. Postoperatively, two dose of leuprolide acetate 11.25 mg (Lucrin depot®—3M; Abbot, Istanbul, Turkey) was prescribed (6 months total). On her sixth month, there was no cyst on transrectal ultrasonography examination. The patient did not exhibit any symptoms. Conclusions: Because the disease affects adolescent girls, fertility issues should be kept in mind during the workup and when operating on these patients. Hysteroscopy is a mini-invasive, safe, and effective option for the treatment of juvenile cystic adenomyosis.

MRI Imaging of Focal Adenomyosis and Adenomyotic Cyst: Case Report

Adenomyosis is defined by the presence of ectopic endometrial glands and stroma within the myometrium. This happens when the normal boundary between the endometrial basal layer and the myometrium is disrupted. It proposed that it may be due to uterine trauma, pregnancy, postpartum endometritis, or caesarean delivery. Adenomyosis has been noted to occur in about 30% of the general female population and the reported prevalence of adenomyosis in hysterectomy specimens varies from 5% to 70%. We report a case of a 42 year old female, nulligravida, with a medical history of complete spontaneous miscarriage five years ago; with uncontrolled bleeding which it need to be treated with cervical cerclage. Actually she has a menstrual menometrorrhagia and dysmenorrhea treated with oral contraceptive pills but it did not stop. Transvaginal sonography showed a globular uterine enlargement with one leiomyoma and uterine wall thickening. Vascular malformation or adenomyosis were suspected. A MRI was performed which it showed findings in respect with adenomyosis.

Deep Adenomyosis

Adenomyotic cysts are frequently implicated with dysmenorrhea and menometrorrhagia [ 1 Preutthipan S. Herabutya Y. Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and/or dysmenorrhea. J Obstet Gynaecol Res. 2010; 36: 1031-1036 Crossref PubMed Scopus (16) Google Scholar , 2 Dakhly D.M. Abdel Moety G.A. Saber W. Gad Allah S.H. Hashem A.T. Abdel Salam L.O. Accuracy of hysteroscopic endomyometrial biopsy in diagnosis of adenomyosis. J Minim Invasive Gynecol. 2016; 23: 364-371 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 3 Gordts S. Campo R. Brosens I. Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis. Gynecol Surg. 2014; 11: 273-278 Crossref PubMed Scopus (42) Google Scholar , 4 Basak S. Saha A. Adenomyosis: still largely under-diagnosed. J Obstet Gynaecol. 2009; 29: 533-535 Crossref PubMed Scopus (17) Google Scholar ]. Endometrial resection was performed in a 29-year-old woman suffering with menorrhagia and dysmenorrhea. Suddenly, a large crater-like tear appeared over the left posterolateral uterine cavity wall and brownish turbid fluid began gushing out; this was momentarily confused with a perforation (Fig. 1). Within about 15 seconds the initially gushing brownish fluid was reduced to a mere trickle, which finally stopped. A closer inspection of the ruptured cavity revealed the dark red mucosal lining of an approximately 10-mm cyst (Fig. 2), the wall of which was accidentally cut during endometrial resection. The myometrium adjacent to the cystic crater was resected only to find that the crater was extending deep into the myometrium (Fig. 3). The entire cyst was carefully resected along with its mucosal lining. The surgery was completed satisfactorily, and the postoperative period was uneventful. The histopathology of the endomyometrial tissue pieces revealed myometrium with adenomyosis and endometrium in the proliferative phase. Three years after the surgery the patient is symptom free with respect to menorrhagia and dysmenorrhea. Rupture of an adenomyotic cyst is a rare complication associated with endometrial resection, but it can unnecessarily alarm a surgeon who encounters it for the first time. Fig. 2The myometrial cyst cavity is seen lined by reddish mucosa. View Large Image Figure Viewer Download Hi-res image Fig. 3A crater-like ruptured cyst extending deep into the myometrium. View Large Image Figure Viewer Download Hi-res image

Huge Adenomyotic Cyst in Pregnancy

Adenomyotic cyst is a rare variant of adenomyosis. It is believed to arise from repeated focal haemorrhages resulting in cystic spaces filled with altered blood products. We present a rare case of a huge adenomyotic cyst in a 27-year-old primigravida, who was in her first trimester, complaining of sudden lower abdominal pain. Diagnostic laparoscopy performed to rule out other cause of acute abdomen. Her pregnancy went on smoothly. She delivered a baby girl of 2.82 kg via vaginal delivery at 39 weeks. Diagnosis and management of this rare clinical entity were reviewed and discussed.

Serous carcinoma arising from uterine adenomyosis/adenomyotic cyst of the cervical stump: a report of 3 cases

BackgroundSerous carcinoma arising in adenomyosis and adenomyotic cyst is very rare. Only 3 serous carcinomas and 5 serous endometrial intraepithelial carcinomas (EIC) have been reported to date.MethodsWe reviewed the clinicopathological features of 2 serous carcinoma in uterine adenomyosis and 1 serous EIC in adenomyotic cyst of the cervical stump.ResultsCase 1 had an endometrial serous carcinoma in the uterine myometrium and the left ovary. A minor component of benign endometrial glands with minimal endometrial stroma was found in the uterine mass and the surrounding myometrium. Case 2 showed 3 small foci of serous carcinoma, serous EIC and endometrial glandular dysplasia (EmGD) in the adenomyosis. Scanty serous carcinoma was present in the endometrium without evidence of myometrial invasion. The eutopic endometrium in both case 1 and 2 had no evidence of neoplastic changes after complete examination. Case 3 had 3 microscopic serous EICs in the adenomyotic cysts of the cervical stump. One EIC lesion coexisted with EmGD. No cancer was found in the endocervical tube although the preoperative endocervical biopsy showed a poorly differentiated endometrioid carcinoma. Immunohistochemistry demonstrated that serous carcinoma in case 1 and EIC in all 3 cases showed a characteristic pattern of p53 and p16 over expression, high Ki67 index, and lack of WT1, ER and PR staining. EmGD in case 1 and 3 had a similar staining pattern except a lower Ki67 index and the presence of ER expression.ConclusionsWe believe that this case series may expand our recognition on serous carcinoma arising in uterine adenomyosis/adenomyotic cyst including extra-uterine spread and the potential synchronous growth of carcinomas in eutopic endometrium.

Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis.

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.

Adenomyotic cyst of the uterus associated with pelvic pain: A case report

Adenomyotic cysts of the uterus are extremely rare and this case report is to document an adenomyotic cyst of the uterus associated with pelvic pain. A 27-year old nulliparous patient admitted to the hospital with the complaint of dysmenorrhea, dyspareunia and pain in the right pelvic region for the last 3 months. Transvaginal ultrasonographic examination revealed a 50 × 36 mm intramural cystic lesion on the right region of the corpus uteri. Hysteroscopic examination showed that it did not deteriorate the endometrial cavity. During laparatomy dissection of the uterine wall revealed 5 cm cystic lesion that was excised circumferentially protecting the surrounding myometrial tissue. The definitive pathology report came out as adenomyotic tissue. Imaging techniques are critical in differential diagnosis of adenomyotic cysts and to choose the appropriate intervention. Medical therapy or surgical intervention like excision of the cyst or hysterectomy may be the choices of treatment.

Adenomyotic cyst of the uterus associated with pelvic pain: A case report

Uterusun adenomyotik kistleri cok nadirdir ve bu vaka sunumunda pelvik agri ile iliskili uterusun adenomyotik kisti sunulmustur. 27 yasindaki nulligravid hasta dismenore, disparenu ve son 3 aydir devam eden sag pelvik agri sikayeti ile hastaneye basvurmustur. Transvajinal ultrasonografide uterus korpusunun saginda 50 × 36 mm intramural kistik lezyon saptandi. Histeroskopik incelemede lezyonun endometrial kaviteyi etkilemedigi izlendi. Laparatomi sirasinda cevre myometrial doku korunarak 5 cm boyutundaki kist cepecevre diseke edilerek cikarildi. Patoloji sonucu adenomyotik doku olarak geldi. Goruntuleme yontemleri adenomyotik kistlerin ayirici tanisinda ve uygun tedavinin seciminde onemlidir. Medikal tedavi veya kistin eksizyonu ya da histerektomi gibi cerrahi yaklasimlar tedavi secenekleri olabilir.

子宮内腔より “筋腫分娩” 様に発育したadenomyotic cystの1例

子宮内腔より “筋腫分娩” 様に発育したadenomyotic cystの1例

Recurrent Prolapsed Giant Uterine Polyp Comprised of Adenomyotic Cysts

The commonest pathologic diagnosis of large prolapsed polyps is leiomyoma. Benign or malignant adenomyomatous polyps follow. Adenomyotic cyst is a rare form of adenomyosis. To our knowledge, a recurrent prolapsed giant uterine polyp comprised of adenomyotic cysts and with different pathogenesis from the original polyp has not been reported in the literature. This case report describes a 29 year old woman with meno/metrrorrhagia, who was found to have a large recurrent uterine polyp prolapsed into the vagina at two and a half years after removal of an initial large uterine polyp. The initial polyp was a large uterine leiomyoma protruding through cervix. The recurrent giant polyp was comprised of adenomyotic cysts. Thus, this case report demonstrates that a prolapsed giant polyp of the uterine corpus can be caused by enlarged adenomyotic cysts inside the polyp. The pathogenesis of a recurrent uterine polyp may be different from that of the initial polyp.

Laparoscopic Wedge Resection of Adenomyosis

Introduction: adenomyosis is a smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually present with monthly pain due to embedded blood in the adenomyotic cyst. Results: Diagnosis is established on transvaginal ultrasound and this also will guide you choosing the correct management approach. This video shows ultrasound pictures MRI and present laparoscopic wedge resection. Conclusion: Adenomyomis uteri is rare, however ultrasound detect the clinical situation and guide the endoscopic approach.

An update on adenomyosis in the adolescent

Limited evidence is available on the diagnosis and management of adenomyosis in adolescents. This review highlights the postulated pathophysiologic mechanisms, the prevalence of the condition among adult women and new reports of adenomyosis or adenomyotic cysts occurring in adolescents. Diagnostic criteria as well as treatment options are discussed. Very few cases of adenomyosis conditions are reported in the literature, and management schemes differed with regard to medical versus surgical approaches. It is clear from reports in adolescents presenting with severe refractory dysmenorrhea that MRI can help establish a diagnosis of adenomyosis, possibly avoiding or delaying surgery to allow for medical management in some cases. Adenomyosis may be present during adolescence. Because mechanisms of disease appear to be similar, goals of treatment in the adolescent are toward fertility preservation. Medical management appears to be a good option for certain types of adenomyosis, although surgery may be appropriate in the case of well circumscribed adenomyotic cysts, adenomyomas or noncommunicating horns.

Treatment and Diagnosis of Adenomyoma Uteri

Study Objective: Introduction: An adenomyoma is a benign tumor composed of smooth muscle cells and endometriosic tissue, typically originating within the uterus. Methods: These patients usually present with monthly pain due to embedded blood in the adenomyotic cyst. Results: Diagnosis is established on transvaginal ultrasound and this also will guide you choosing the correct management approach. This video shows ultrasound pictures and present hysteroscopic, and laparoscopic treatment of the problem.

Laparoscopic resection of cystic adenomyosis in a teenager with arcurate uterus

Whereas diffuse adenomyosis is a common finding in parous women, cystic adenomyosis causing severe dysmenorrhoea is very rarely reported and possibly under-diagnosed, particularly in adolescents. We report a case of juvenile cystic adenomyosis in a 19-year-old nulliparous patient presenting with secondary dysmenorrhoea and non-cyclical pain. A 20-mm adenomyotic cyst in the fundal myometrium was successfully excised laparoscopically by modified myomectomy. It is mandatory to take persistent primary and early secondary dysmenorrhoea seriously, especially after poor response to medical treatment and to have a low threshold for further investigations, because a diagnosis of cystic adenomyosis requires targeted therapeutic intervention.