Introduction: Uterine cystic adenomyosis is a rare proliferative disease in which the endometrial tissue focally repeats hemorrhage in the myometrium and forms cystic lesions. We report a case of uterine cervical cystic adenomyosis for which we performed total laparoscopic hysterectomy (TLH) with two techniques to avoid urinary tract injury.
Case: The patient was a 45-year-old woman with G0 who had two times of surgery for endometriosis. A local doctor diagnosed uterine cervical cystic adenomyosis about 30 mm in diameter and followed her up. Due to the worsening dysmenorrhea and the enlarging cystic lesion, she was referred to our hospital for treatment. Pelvic MRI showed uterine cervical adenomyosis about 35 mm in diameter and diffuse adenomyosis of the uterine body. TLH was performed because of the worsening dysmenorrhea due to uterine adenomyosis. Anatomical change due to a cervical tumor and severe adhesions because of endometriosis were expected; hence, we carried out two techniques. Firstly, urinary catheters were preoperatively placed, secondary, we injected air into the bladder when the uterus and the bladder were detached, then, TLH was safely completed while monitoring the bladder wall. Histopathology showed endometrial glands in the cervical myometrium, and uterine cervical cystic adenomyosis was diagnosed. Her symptoms have improved, and no recurrence after surgery has been observed.
Discussion: Cystic adenomyosis is rarer in the cervix than in the uterine body. There is no report about TLH for uterine cervical cystic adenomyosis. A difficult surgery was expected due to a cervical tumor and endometriosis, but the urinary tract injury was avoided using two techniques, and the surgery was safely completed.