Management of Myometrial Cystic Adenomyosis

This chapter focuses on a rare entity of focal adenomyosis, namely the type with large cystic lesions occurring within a focal area of adenomyosis or cystic adenomyosis. The cystic part of the nomenclature refers to a distinct cavity that forms within the myometrium and contains evidence of hemorrhage and bleeding that is comparable to the “chocolate-like” material of an endometrioma. Adenomyosis is defined by the presence of endometrial stroma and glands within the myometrium of the uterus. Cystic lesions in the literature were reported as early as 1908. The exact mechanism of adenomyosis is largely unknown and based on theoretical pathological processes. The focal form of adenomyosis is much less common than the diffuse form. Conservative therapy with medical management should be thoroughly explored and does depend on the patients' goals of treatment. Medical treatment can include nonsteroidal anti-inflammatory drugs (NSAIDs) and other over-the-counter analgesics.