Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

Abstract

Background: A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of adenomyosis.

Case summary: Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device (LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera, surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.

Conclusion: We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Keywords: Case report; Cystic adenomyosis; Dysmenorrhea; Levonorgestrel containing intrauterine device; Myomectomy.

Figure 1

Imaging examinations. A: B-mode ultrasound showed an anterior and normal uterus size and a cystic echogenic mass that measured 9.5 cm × 7.4 cm × 7.4 cm located at the posterior uterine isthmus. The white arrow indicates an intrauterine device contained within this cystic mass; B: On the T1-weighted image, the uterine isthmus muscle was discontinuous, and the cervical canal lost its normal shape. A communication was observed between the posterior isthmus of the uterus and the endometrial cavity and cervical canal.

Figure 2

Laparoscopic excision of the mass was performed for the patient. A and B: Appearance of the cystic adenomyosis at different directions; C: Chocolate-colored liquid content overflowed from the incision; D: The incision was enlarged and a levonorgestrel-containing intrauterine device was exposed after sucking the cystic fluid; E: The cervical canal was enlarged by the expanding-uterus stick to prevent stenosis; F: Continuously suturing the entire uterine wall twice to reconstruct the uterine wall.