1. 27-year-old patient with adenomyotic cyst: case report Lőrincz, Judit1; Jakab, Attila2, Török, Péter2 1Kenézy Gyula County Hospital, Department of Obstetrics and Gynaecology, 2University of Debrecen Medical and Health Science Center, Department of Obstetrics and Gynaecology
BACKGROUND
An adenomyotic cyst is an extremely infrequent manifestation of adenomyosis. Therefore of an unclear physiopathology adenomyosis is a heterogenous gynecologic condition. The most common appearance of adenomyosis is the diffuse form, but it can also present as a focal lesion defined as adenomyoma.  Due to literature data, an adenomyotic cyst is more commonly encountered in younger patients. Diagnosis of adenomyosis is difficult due to the lack of specific symptoms. Moreover there is no effective conservative treatment.
CASE REPORT
A 27 year-old nulligravida presented with a history of consistently appearing pelvic pain. By ultrasonography a well-circumscribed mass was identified on the right side of the uterine wall.  Different management options are available according to age and anatomical localization of the cystic mass. At that point, surgical evaluation was recommended. Laparoscopy was performed: the uterine lesion was identified on the right portion of the uterine fundus. The first step of the intervention was the recognition of the lesion’s location and borders by inspection and palpation (fig.1). Then an incision of the uterine wall along the adenomyoma was performed. (fig.2) A sharp and blunt dissection of the lesion with monopolar hook instrument and graspers was carried out. When the cyst ruptured, copious amount of chocolate-like material spilled over. (fig.3) Suturing of the uterine wall in a seromuscular layer with absorbable suture was necessary. (fig.4) Histopathology of the specimen demonstrated cystic adenomyosis. After the surgery and at the 6-week follow-up examination the patient reported to be symptom-free.
DISCUSSION
Adenomyosis is a common non-neoplastic condition however cystic adenomyosis represents a rare entity. Diagnosis and treatment of these cases are great difficulties due to the diverse manifestation of the disease. In our case we managed to find a minimally invasive approach that successfully eliminated the patient’s severe symptoms.
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