A case of large uterine cystic adenomyosis outside the uterus after laparoscopic myomectomy: a case report and literature review

Abstract

Background: Uterine cystic adenomyosis is a rare form of focal adenomyosis that is primarily located within the myometrium. In this case report, we present a unique case of adult uterine cystic adenomyosis found outside the uterus following laparoscopic myomectomy.

Case presentation: The patient was a 36-year-old Chinese woman who had previously undergone laparoscopic surgery at our hospital to remove a 4 cm diameter diameter uterine fibroid six years prior. She returned to our hospital due to excessive menstruation and intermittent right lower abdominal pain for one year. Pelvic computed tomography revealed an endometriotic cyst on the right posterior side of the uterus seemingly connected to the uterine cavity. During surgery, we successfully removed a large well-defined cyst filled with typical chocolate-like fluid located outside the uterus with its root deeply embedded in the myometrium. Following surgery, we administered gonadotropin-releasing hormone analogs for six cycles without any observed recurrence.

Conclusion: This study describes an unusual occurrence of large adult uterine cystic adenomyosis located outside the uterus after laparoscopic myomectomy, potentially supporting the theory that endometrial injury invagination may be responsible for this condition.

Keywords: Laparoscopic myomectomy; Uterine cystic adenomyosis; Uterine fibroids.

Fig. 1

Imaging findings during the patient’s hospitalization. A Pelvic CT scan during the first hospitalization revealed a 4 cm diameter uterine fibroid with cystic degeneration located in the right posterior uterine wall near the isthmus of the cervix B, C Follow-up pelvic CT scan during the second hospitalization revealed a multilocular cystic mass situated on the right posterior side of the uterus that appeared to communicate with the uterine cavity D The second admission CT scan revealed that the cyst was located in the same anatomical site as the uterine fibroid identified on the initial admission CT scan (The uterine artery was used as a reference) E During the second hospitalization, pelvic ultrasound identified a solid-cystic mass measuring 7.5 × 5.5 × 4.7 cm in size within the right adnexal area

Fig. 2

Laparoscopic findings observed during the patient’s second hospitalization. A Laparoscopic exploration revealed a well-defined, large cyst located in the posterior wall of the uterus on the right side, while both adnexa were normal B, C The root of the cyst was deeply embedded in the myometrium, and its contents consisted of a typical chocolate-like fluid D There was communication between the cyst and the uterine cavity E, F 1 − 0 absorption line was utilized for suturing the uterine muscle layer and plasma muscle layers