A case report on cystic adenomyosis: A rare variant of uterine adenomyosis

Background: Cystic adenomyosis is a rare variant of adenomyosis that can easily be misdiagnosed, due to the non-specific nature of symptoms. USS and MRI are essential in making a diagnosis which is later confirmed through histopathological evaluation. Surgical interventions are favored over medical management, as complete resection reduces the risk of recurrences and alleviates the chances of malignant transformation.Case presentation: A 37-year-old multipara presented with chronic abdominal pain, exacerbated by menstruation, lasting most days of the month for over one year. Clinical evaluation revealed a tender, less mobile pelvic mass which mimicked an intramural fibroid on USS. Considering the long-standing symptoms and lack of fertility wishes, she underwent a laparotomy. During surgery, an unexpected finding of chocolate-colored exudate with a thick epithelium-lined myometrial cystic lesion was noted. Histopathology evaluation revealed fragmented tissue composed of smooth muscle bundles and are lined by endometriotic type epithelium and stroma. There was no malignant changes. Overall findings are in favor of cystic adenomyosis.Discussion and conclusions: Cystic adenomyosis is considered to arise due to persisting mullerian epithelial cells stimulated by estrogen leading to periodic bleeding into the myometrium. Surgery of the myometrium can also introduce endometrial tissue to the myometrium. To preserve the quality of life and reduce the risk of recurrence, minimal access surgery should be carried out.Even though rare, a young woman presenting with chronic pelvic pain, and not responding to analgesics should raise the possibility of cystic adenomyosis, which should warrant further investigation and treatment.