A case of cystic adenomyosis presenting as uterine malignancy on gross appearance

Adenomyosis of uterus is a relatively common condition and is usually divided into two main types, the diffuse adenomyosis and focal adenomyosis. However, there is third rare variant called as cystic adenomyosis which is due to repeated focal haemorrhages and results in cystic spaces filled with altered blood. Here, we are presenting a unique case of 25 years old girl who presented with severe dysmenorrhoea with 26 weeks abdominal lump. USG showed uterine fibroid with right ovarian chocolate cyst. Patient was planned for myomectomy with cystectomy. Intraoperatively large, irregular solid cystic mass (25x15x10 cm3) was removed which appeared malignant and total hysterectomy with bilateral salpingectomy was done. But mass was identified as cystic adenomyosis associated with diffuse adenomyosis of uterus on histopathology. Thus, although rare, but adenomyosis may be abnormally enlarged, solid, irregular, malignant in appearance and MRI may be required preoperatively for correct diagnosis and plan of management.