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• W2024894088 abstract "We describe a 37-year-old woman with giant cystic adenomyosis who underwent a hysterectomy, providing magnetic resonance imaging and gross and microscopic images. We describe a 37-year-old woman with giant cystic adenomyosis who underwent a hysterectomy, providing magnetic resonance imaging and gross and microscopic images. The patient was a 37-year-old woman who had undergone myomectomy twice at ages 26 and 31 years, and dilation and curettage twice for evacuation of a hydatidiform mole at 29 years. At 32 years, she started to have abdominal cramps and menorrhagia. A cystic mass in the uterine wall was identified; by 35 years, she had undergone four vaginal aspirations of chocolate-like fluid (20–30 mL) followed by ethanol, minocycline, and danazol infusions. She became pregnant at 36 years, and was delivered by cesarean. After the delivery, her symptoms worsened, and she was referred to us. Magnetic resonance imaging (MRI) revealed a 17 × 11 × 8-cm cystic mass in the uterine wall, which was suspected to be a cystic adenomyosis (Fig. 1). Despite treatment by gonadotropin-releasing hormone (GnRH) analogue, the size and her symptoms remained unchanged. She underwent a hysterectomy thereafter. The cyst contained 1150 mL of serous non-colored clear fluid, and the cut surface was smooth and white (Fig. 2). Under microscopic examination, the cyst was found to be mostly lined by stratified squamous cells (Fig. 3a), and partially lined by endometrial-like epithelia with squamous metaplasia (see Fig. 3b). These features suggested cystic adenomyosis with epithelial metaplasia.FIGURE 2Gross appearance of the uterus. The surface of the cyst was smooth and white.View Large Image Figure ViewerDownload (PPT)FIGURE 3Microscopic appearance of the cystic wall. (a) The cyst was mostly lined by stratified squamous cells. (b) The cyst was partially lined by endometrial-like epithelia with squamous metaplasia. (Hematoxylin-eosin stain; magnification ×200.)View Large Image Figure ViewerDownload (PPT) This is the first report of a cystic adenomyosis that contained more than 1000 mL of fluid and showed extensive metaplasia. Prior uterine surgery is known to be a risk factor for adenomyosis (1Panganamamula U.R. Harmanli O.H. Isik-Akbay E.F. Grotegut C.A. Dandolu V. Gaughan J.P. Is prior uterine surgery a risk factor for adenomyosis?.Obstet Gynecol. 2004; 104: 1034-1038Crossref PubMed Scopus (45) Google Scholar), and squamous metaplasia of eutopic endometrium has been described from hormonal disturbances like progestin therapy (2Miranda M.C. Mazur M.T. Endometrial squamous metaplasia. An unusual response to progestin therapy of hyperplasia.Arch Pathol Lab Med. 1995; 119: 458-460PubMed Google Scholar), chronic irritation including intrauterine devices (3Lane M.E. Dacalos E. Sobrero A.J. Ober W.B. Squamous metaplasia of the endometrium in women with an intrauterine contraceptive device follow-up study.Am J Obstet Gynecol. 1974; 119: 693-697PubMed Scopus (9) Google Scholar), or inflammation due to artery embolization (4Hameed M. Heller D.S. Murphy G. Squamous metaplasia of endometrium after uterine artery embolization for symptomatic leiomyomata.J Am Assoc Gynecol Laparosc. 2002; 9: 70-72Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). In this case, repeated surgical interventions are suspected to have induced the cystic adenomyosis, and the pharmacologic interventions might have contributed to the squamous metaplasia in the epithelium of cystic adenomyosis." @default.
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• W2024894088 date "2006-03-01" @default.
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• W2024894088 title "A case of giant cystic adenomyosis" @default.
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• W2024894088 doi "https://doi.org/10.1016/j.fertnstert.2005.11.028" @default.
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