Adenomyotic cyst mimicking a congenital Müllerian anomaly: Diagnosis and treatment with laparoscopy

Abstract

A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder.

Keywords: Adenomyotic cyst; Dysmenorrhea; Laparoscopy; Obstructive Müllerian anomaly.

Figure 1.

Sonographic finding of a bicornuate uterus with an anechoic collection measuring 3.3×1.2 cm in the left horn (black arrow).

Figure 2.

Hysteroscopic view showing bilateral ostia (solid arrows) with mild adhesion at the fundus (hollow arrow).

Figure 3.

Laparoscopic view of the cystic lesion. (A) Uterus with an anterolateral adenomyotic cyst on the left side of the uterine fundus (arrow). (B) Aspiration of chocolate-colored fluid from the cyst. (C) At the time of cyst excision, a cystic cavity with chocolate-colored fluid was clearly seen (arrow). (D) The uterine myometrium was closed laparoscopically in two layers with continuous sutures.