Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan.
Institute of Medical Sciences, Collagen of Medicine, Tzu Chi University, Hualien, Taiwan.
Medicine (Baltimore). 2023 Nov 17;102(46):e36089. doi: 10.1097/MD.0000000000036089.
Adenomyosis, a gynecological condition characterized by endometrial tissue within the uterine myometrium, often leads to menstrual pain and heavy bleeding, significantly affecting the quality of life. The primary treatment for adenomyosis and leiomyomas is hysterectomy. However, in rare instances, these conditions can recur in the cervical stump following a hysterectomy.Here, we present a case of cervical adenomyoma development after a prior laparoscopic supracervical hysterectomy.
A 47-year-old woman sought medical attention due to increased vaginal bleeding.
She had undergone a laparoscopic supracervical hysterectomy 7 years earlier to address uterine myoma and adenomyosis. Just 1 month posthysterectomy, a pelvic ultrasound revealed the presence of a cervical stump measuring approximately 4.0 × 4.0 cm. Subsequent follow-up ultrasounds documented the gradual growth of the cervical mass. Two years ago, a recurrent myoma was identified, and the patient experienced intermittent vaginal bleeding. Over 7 years, the cervical mass increased from 4 to 7 cm. Preadmission pelvic ultrasonography confirmed the existence of cervical adenomyoma measuring 7 × 6 cm.
Consequently, the patient underwent a laparoscopic trachelectomy. Intraoperatively, an enlarged cervix, approximately 7 × 6 cm in size, containing adenomyoma was observed. A gross examination of the specimen indicated hypertrophic muscle tissue and hemorrhagic foci. Subsequent histopathological examination confirmed the presence of adenomyoma.
Remarkably, the patient exhibited no recurrence over the subsequent 8 months.
The case presented here highlights the potential occurrence of cervical adenomyoma following a supracervical hysterectomy. Management options include hormone therapy and surgical excision. Furthermore, annual follow-up comprising ultrasound and pap smear evaluations is recommended for patients with supracervical hysterectomies to detect and address possible recurrences.
子宫腺肌病是一种妇科疾病，其特征为子宫内膜组织出现在子宫平滑肌内，常导致月经疼痛和大量出血，显著影响生活质量。子宫腺肌病和子宫肌瘤的主要治疗方法是子宫切除术。然而，在极少数情况下，这些疾病在子宫切除术后宫颈残端可能会复发。在此，我们报告了一例先前腹腔镜子宫次全切除术后宫颈腺肌瘤的病例。
一位 47 岁女性因阴道出血增多就诊。
7 年前，她因子宫肌瘤和子宫腺肌病接受了腹腔镜子宫次全切除术。子宫切除术后 1 个月，盆腔超声显示宫颈残端约 4.0×4.0cm。随后的随访超声显示宫颈肿块逐渐增大。2 年前，发现复发性子宫肌瘤，患者间歇性阴道出血。7 年来，宫颈肿块从 4cm 增大至 7cm。入院前盆腔超声证实存在大小为 7×6cm 的宫颈腺肌瘤。
因此，患者接受了腹腔镜宫颈锥切术。术中观察到宫颈增大，约 7×6cm，内含腺肌瘤。大体检查标本提示肌肉组织肥厚和出血灶。随后的组织病理学检查证实了腺肌瘤的存在。
令人惊讶的是，患者在接下来的 8 个月内未出现复发。
本病例提示子宫次全切除术后可能发生宫颈腺肌瘤。治疗选择包括激素治疗和手术切除。此外，对于接受子宫次全切除术的患者，建议每年进行超声和巴氏涂片检查随访，以发现和处理可能的复发。
