EP26.09: Fibroid or endometriosis in the uterine wall?

Adenomyosis is a common form of endometriosis, its diffuse type is often seen in patients suffering from this disorder. Focal adenomyosis presenting cysts in the uterine wall is a quite rare condition causing debate on the preoperative diagnosis. In our case report a 31 year-old patient is presented who was admitted to our department due to her fibroid related symptoms – chronic pelvic pain – before her planned pregnancy. Previously an ultrasound scan performed revealed a 16 mm structure in the uterine wall which was later described as a fibroid. The patient attended regular checkups and her complaints also progressed by the time. Repeated ultrasound examination showed a well circumscribed, hypoechogenic, 3.5 cm in diameter structure in the uterine wall, separated from the endometrial cavity. Although the appearance of this structure could fulfil the requirements of an emolliated fibroid. Laparoscopy was performed in order to remove the tumour and an adenomyotic cyst was found in the uterine wall. The most of the inner lining was removed and electrocoagulated followed by closing the wound with baseball stitches. Patient discharged the following day. Final histopathological result proved adenomyosis. 3 months after the surgery no recurrence was seen and the patient was under GnRh analogue therapy. Preoperative CA125 was not measured. 7 months after the treatment the patient has managed to conceive successfully without any pregnancy loss. Preoperative imaging is the key in distinguishing adenomyotic cyst from other congenital and acquired gynecological pathologies. The surgical treatment is the excision of the lesion and should be conservative. Since adenomyotic patients are usually young, laparoscopic excision is considered optimal. Being a rare condition we have to keep in mind this uncommon localisation for endometriosis.