Juvenile cystic adenomyoma, a rare diagnostic challenge: Case Reports and literature review.

OBJECTIVE

To report 2 very rare cases of young women who presented with severe dysmenorrhea and a large cystic lesion in the myometrium, which presented a diagnostic dilemma because they were confused with a Müllerian anomaly.

DESIGN

Case reports and a literature review.

SETTING

A university-based reproductive endocrinology and infertility clinic in the United States.

PATIENTS

An 18- and a 16-year-old nulliparous girl presented with worsening of their longstanding pelvic pain, and imaging study results were suggestive of a Müllerian anomaly.

INTERVENTIONS

Abdominal and pelvic computed tomography, transvaginal ultrasonography, pelvic magnetic resonance imaging, operative laparoscopy, and excision of a juvenile cystic adenomyoma (JCA).

MAIN OUTCOME MEASURES

Resolution of the pelvic pain and restoration of normal uterine anatomy after appropriate intervention.

RESULTS

Restoration of normal uterine anatomy, which was confirmed by 3-dimensional ultrasonography for case 1; however, case 2 still had a small remnant of JCA postoperatively.

CONCLUSIONS

Clinical and radiologic examinations may not be useful in differentiating a Müllerian anomaly from other rare abnormalities like JCA. When in doubt, laparoscopy can assist in diagnosing and treating the condition.