Adenomyotic Cyst Masquerading as a Subserosal Fibroid: Always a Laparoscopic Surprise?

Area of Science:

• Gynecologic Surgery
• Diagnostic Imaging
• Reproductive Medicine

Background:

• Adenomyotic cysts are rare, often misdiagnosed as uterine fibroids.
• Symptomatic adenomyosis can cause chronic pelvic pain and heavy menstrual bleeding.

Purpose of the Study:

• To detail the diagnostic challenges and laparoscopic management of a symptomatic adenomyotic cyst.
• To highlight the utility of intraoperative indocyanine green in differentiating adenomyotic cysts from fibroids.

Main Methods:

• Case report of a 41-year-old woman with chronic pelvic pain and dysmenorrhea.
• Transvaginal ultrasound revealed a cystic mass suspected to be a fibroid or Müllerian anomaly.
• Laparoscopic excision with intraoperative indocyanine green assessment was performed.

Main Results:

• Histopathology confirmed the lesion as an adenomyotic cyst, not a fibroid.
• The patient achieved complete resolution of pelvic pain post-surgery.
• Indocyanine green demonstrated atypical fluorescence, aiding intraoperative diagnosis.

Conclusions:

• Adenomyotic cysts can present as uterine masses mimicking fibroids.
• Indocyanine green fluorescence is a valuable tool for intraoperative diagnosis of adenomyotic cysts.
• Laparoscopic management allows for accurate diagnosis and uterus-sparing treatment.