Laparoscopic resection of cystic adenomyosis in a teenager with arcurate uterus

Abstract

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.

Adenomyosis in an 18-Year-Old Adolescent: A Case Report

“…Careful review of the literature reveals very few case reports, case series or small cohorts addressing adenomyosis or adenomyotic cysts presenting in the female adolescent [3,4,7,11,12]. A variety of imaging modalities were utilized in diagnosis.…”

“…, Ana Katherine Gonçalves 3 and Ricardo Ney Cobucci 4 uteri and often associated with the diffuse subtype, and in a juvenile form seen in nulliparous women between 13 and 20 years of age, for which the true incidence is not known, since few cases have been reported. Although adenomyosis seems very rare before age 20, a cystic form has mainly been reported in young women [3,4].…”

“…Although adenomyosis seems very rare before age 20, a cystic form has mainly been reported in young women [3,4].…”

Surgical management of cystic adenomyosis. Why the laparoscopic approach is preferable?

“…it is typically diagnosed in parous women and is thought to affect 1% of women, typically diagnosed in the 4 th and 5 th decades of life (1,2). the diffuse form, characterized by the presence of blood-filled cystic spaces, < 5 mm in greatest diameter (3,4), is typically diagnosed in multiparous premenopausal women and is present in up to 20% of hysterectomy specimens (5). Focal adenomyosis rarely occurs.…”

“…in juvenile patients, clinical findings are not specific and early presentation of symptoms can be misleading. differential diagnosis includes primary dysmenorrhea, ovarian endometriomas, degenerative fibroids and bicornuate uterus with non-communicating uterine horn (5). diagnostic criteria are considered: cystic lesion 1 cm or greater in diameter, independent of the uterine endometrial cavity, covered by hypertrophic myometrium and associated severe dysmenorrheal (7).…”