Laparoscopic resection of cystic adenomyosis in a teenager

Whereas diffuse adenomyosis is a common finding in parous women, cystic adenomyosis causing severe dysmenorrhoea is very rarely reported and possibly under-diagnosed, particularly in adolescents. We report a case of juvenile cystic adenomyosis in a 19-year-old nulliparous patient presenting with secondary dysmenorrhoea and non-cyclical pain. A 20mm adenomyotic cyst embedded in the in the anterior fundal myometrium of a bicornuate uterus was successfully excised laparoscopically by modified myomectomy. Preoperative differential diagnoses included uterine myoma, unicornuate uterus with non-connecting rudimentary uterine horn and ovarian endometrioma.

This case illustrates the importance of connecting patient symptoms, clinical examination and imaging with findings at explorative laparoscopy in order to reach the correct diagnosis and provide optimal treatment. Thus it is mandatory to take persistent primary and early secondary dysmenorrhoea seriously, especially after poor response to medical treatment and to have a low threshold for further investigations because a diagnosis of cystic adenomyosis requires targeted therapeutic intervention.

adenomyoma - juvenile cystic adenomyosis - laparoscopy