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| CASE REPORT |
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| Year : 1990 | Volume
: 36
| Issue : 1 | Page : 46-7 |
Cystic degeneration in an adenomyoma (a case report).
Parulekar SV
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Bombay, Maharashtra.
Correspondence Address:
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Bombay, Maharashtra.
Cystic degeneration though often seen in a leiomyoma, has not been reported so far in an adenomyoma. Hence, a unique case of cystic degeneration in an adenomyoma of the uterus is presented.
How to cite this article:
Parulekar S V. Cystic degeneration in an adenomyoma (a case report). J Postgrad Med 1990;36:46 |
Cystic degeneration is not an uncommon complication of a uterine leiomyoma[2]. Adenomyoma is a differential diagnosis of a leiomyoma. Cystic degeneration of an adenomyoma has not been described so far in the literature. One such case is presented.
Mrs. KR, a 36-year-old 2nd gravida, 2nd para presented with a complaint of pain in the lower abdomen for one month. She had no other gynaecological complaints. Her menstrual cycles were regular with moderate flow and her last menstrual period had been 10 days ago. She had two normal vaginal deliveries in the past. On examination, her vital parameters were found to be within normal limits. Abdominal examination revealed a firm, rounded lump reaching to 5 cm above the top of the pubis from the pelvis. Bimanual pelvic examination showed the uterus to be uniformly enlarged, continuous with the abdominal mass.
Pc Ivic ultrasonography revealed a uniform uterine enlargement, with a cystic mass in the posterior uterine wall measuring 10 cm x 10 cm. A provisional diagnosis of cystic degeneration of uterine leiomyoma was made.
At exploratory laparotomy, the cystic mass was removed through a transverse incision in the uterine fundus just behind the cornua. Sharp dissection was required there, being no plane for dissection as generally expected in the case of a leiomyoma. Uterine cavity was not reached during the operation.
The incision was sutured by Bonney's hood technique, covering the original incision[1]. Abdominal wall incision was closed in layers. The post-operative recovery was uneventful and the patient was discharged on the eighth post-operative day. Histopathological examination of the mass revealed presence of both endometrial glands and stroma in all the walls of the cystic mass. This examination as well as the operative finding, that the uterine cavity had not been approached, confirms the diagnosis of adenomyoma with cystic degeneration and rules out the provisional diagnosis of leiomyoma.
Cystic degeneration in a leiomyoma is the result of an ischaemia[2]. Such an occurrence is not known with an adenomyoma, because it is not a tumour in the myometrium that can grow and compress its vessels at its periphery, or outgrow the ability of its vessels to feed it. A leiomyoma with cystic degeneration cannot be shelled out easily like an adenomyoma. In the case described, the points supporting the diagnosis of an adenomyoma with cystic degeneration are presence of cystic degeneration, non-difficulty in shelling out the mass, and presence of endometrial glands and stroma in all the walls of the mass. This is the first case of its type in the world literature.
| 1. |
Mattingly RF. Myomata uteri. In: “Te Linde's Operative Gynaecology”. Mattingly RF, editor. 5th edition, Philadelphia, Toronto: JB Lippincott Company; 1977, pp 187-222.  |
| 2. | Novak ER, Woodruff JD. Adenomyosis (adenomyoma) uteri. In: "Novak's Gynecologic and Obstetric Pathology with Clinical and Endocrine Relations". 8th Edition, Philadelphia, London, Toronto: WB Saunders Co; 1979, pp. 280-290.
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