Chua H K Angeline, Goh S Y Charissa, Upamali Varuni, Seet Meei Jiun, Wong P C Adele, Phoon W L Jessie
KK Women's and Children's Hospital, Singapore.
Case Rep Womens Health. 2020 Mar 24;27:e00193. doi: 10.1016/j.crwh.2020.e00193. eCollection 2020 Jul.
Multiloculated pelvic cysts are commonly misdiagnosed as ovarian tumors or malignancies. We report 2 patients diagnosed with subserosal adenomyotic cysts and peritoneal inclusion cysts, mimicking multiloculated pelvic tumors. We discuss their clinical presentation, investigations, operation findings, and histopathology, present a literature review.
Case 1 was a 44-year-old patient with abnormal uterine bleeding. Imaging showed an enlarging multiloculated cystic structure over the right uterine wall. She underwent a diagnostic laparoscopy and right salpingo-ophorectomy. Intra-operatively, she was found to have multiple subserosal uterine cysts, diagnosed as adenomyotic cysts on histology.Case 2 was a 50-year-old patient with history of laparoscopic cystectomy done 20 years ago. She was incidentally found to have a multiloculated cystic lesion in the pelvis. The lesion was located midline, anterior and superior to the uterus and bladder. She underwent a total abdominal hysterectomy, bilateral salpingo-ophorectomy, and bladder peritonectomy. Intra-operatively, multiple cystic lesions were noted over the anterior and fundus of uterus, bladder peritoneum, and pelvic side walls. The condition was confirmed to be peritoneal inclusion cysts on histology.
Subserosal adenomyotic cysts are a rare presentation of adenomyosis. They typically occur in premenopausal women. Treatment is usually by hormonal medications or surgical excision.Many patients with peritoneal inclusion cysts have a history of peritoneal insults. Surgical excision is the most commonly described management as they often mimic malignancy. Both conditions are unusual presentations of multiloculated pelvic masses. A high recurrence rate is found, hence long-term follow-up with imaging is essential.
多房性盆腔囊肿常被误诊为卵巢肿瘤或恶性肿瘤。我们报告2例被诊断为浆膜下子宫腺肌病囊肿和腹膜包涵囊肿的患者，它们酷似多房性盆腔肿瘤。我们讨论其临床表现、检查、手术所见及组织病理学，并进行文献综述。
病例1是一名44岁有异常子宫出血的患者。影像学检查显示右子宫壁上有一个不断增大的多房性囊性结构。她接受了诊断性腹腔镜检查及右侧输卵管卵巢切除术。术中发现她有多个浆膜下子宫囊肿，组织学诊断为子宫腺肌病囊肿。病例2是一名50岁的患者，20年前有腹腔镜囊肿切除术史。她偶然发现盆腔有一个多房性囊性病变。该病变位于中线，子宫和膀胱的前方及上方。她接受了全腹子宫切除术、双侧输卵管卵巢切除术及膀胱腹膜切除术。术中发现子宫前壁和底部、膀胱腹膜及盆腔侧壁有多个囊性病变。组织学检查证实为腹膜包涵囊肿。
浆膜下子宫腺肌病囊肿是子宫腺肌病的一种罕见表现。它们通常发生在绝经前女性。治疗通常采用激素药物或手术切除。许多腹膜包涵囊肿患者有腹膜损伤史。手术切除是最常描述的治疗方法，因为它们常酷似恶性肿瘤。这两种情况都是多房性盆腔肿块的不常见表现。发现复发率较高，因此影像学长期随访至关重要。
