Uterine cystic adenomyosis: a case report

Uterine cystic adenomyosis (CA) is a unique form of adenomyosis with a single or fused lumen of the cystic space exceeding a diameter of 1 cm that typically results in progressively worsening dysmenorrhea. In most cases, the prognosis and pregnancy outcomes of CA remained unclear, and therefore further studies are warranted.

A 19‑year‑old woman was admitted for irregular vaginal bleeding that lasted for more than one month. Transabdominal B-ultrasound examination revealed a hypoechoic nodule measuring approximately 4.8 cm × 3.9 cm × 4.9 cm that is situated on the posterior wall of the uterus, in close proximity to the uterine fundus. The preoperative diagnosis was concluded as a pelvic mass with a cancer antigen 125 (CA125) level of 51.48 U/mL. She accepted a laparoscopic myomectomy and the CA lesion crossing the myometrium was removed. During operation, dense adhesions were found among a portion of the colorectum, omentum, uterus and bilateral adnexal areas. A cystic mass of approximately 7.0 cm × 5.0 cm × 4.0 cm was visible in the posterior wall of the uterus, and a sinus of approximately 1.0 cm in diameter was found to be connected to the uterine cavity at the lower posterior wall of the uterus, and the cystic wall was attached to the endometrium. Based on the classification criteria of MUSCLE (myometrial location, uterine site, structure, contents, level, endometrial or inner lining), the current case is classified as an A1-B1 mixed type. Following surgery, GnRH-a consolidation therapy was applied for 3 months. Such treatment relieved her symptoms and improved her quality of life while preserving her reproductive function.

This is the first reported case of an A1-B1 mixed type CA that was successfully treated by laparoscopic surgery supplemented with GnRH-a consolidation therapy.