Introduction Endometriosis associated pelvic pain (EAPP) is the most common complaint of patients with endometriosis. Nearly, 70% of females with endometriosis present with EAPP while endometriomas are found in 17-44% of patients. Material and Methods A short-term single centre study was carried out in 56 patients in the age group of 15-35 years with complaints of pain and diagnosed as endometriosis either by imaging studies and/or by laparoscopy was given dienogest 2 mg OD, and effect of treatment was seen as improvement of pain score over a period of 3 months. The effect of dienogest was also seen on size of endometrioma. Patients were followed up at 1 and 3 months. Results and DiscussionOut of 56 patients, 38 (67.8%) patients reported their pain relief within 2-5 days after starting dienogest. Out of 41 patients (73%) who had severe pain at enrollment, only 1 patient (1.79%) complained of severe pain at the end of 1 month with dienogest. Successful reduction in endometriotic cyst size (>50%) was seen in 3 patients (5.3%) at the end of 1 month with dienogest. Out of 56 patients, 41 patients (73.2%) had significant pain relief (>30%) at three months of treatment. At the end of 3 months, seven patients (12.5%) had significant cyst size reduction (>50%) with dienogest. No major side effects were noted. Conclusion Dienogest is well tolerated drug for endometriosis showing significant relief of pain. However, it was seen that though endometriomas did not grow during treatment, significant regression was uncommon.

We report an unusual case of a large, broad ligament uterine leiomyoma with cystic degenerations, masquerading as a malignant ovarian tumor on ultrasonography and CT with the diagnostic difficulties posed. A 40-year-old married female presented with complaints of abdominal distention and a palpable abdominopelvic mass occupying whole of lower abdomen. Ultrasonography and CT revealed a large solid mass with cystic areas extending into both uterine adnexa. The patient underwent a laparotomy. Gross examination revealed normal ovaries and a pedunculated mass with prominent cystic honeycomb degenerations, originating from the uterus. The tumor was excised through the peduncle and pathologic evaluation revealed a uterine leiomyoma with cystic degeneration. In conclusion, a large pedunculated leiomyoma with cystic degenerations can mimic a malignant ovarian neoplasm on imaging studies. Therefore, uterine leiomyoma with cystic degenerations should be considered during the differential diagnosis of large adnexal masses. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx.

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IntroductionPrimitive neuroectodermal tumor of the uterus is extremely rare. They occur as either pure primitive neuroectodermal tumors or admixed with neoplasms of mullerian origin.Case presentationA case of uterine primitive neuroectodermal tumor with adenosarcoma in a 50-year-old Asian Indian woman is presented. Histologically, the neoplasm displayed perivascular pseudorosettes and occasional Homer-Wright rosettes. A strong positivity for neuronspecific enolase and synaptophysin was noted, while chromogranin and CD99 were negative. Merging imperceptibly with the neuroectodermal components were the areas of adenosarcoma.ConclusionTo the best of our knowledge, this report represents the second case of a uterine primitive neuroectodermal tumor with an admixed adenosarcoma.

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