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Case Report
Extrauterine adenomyomas managed by laparoscopic excision: Three case reports with different theories of origin
1 FRCOG, MSMEC, Consultant Gynecologist, Endometriosis Specialist, Medcare Women and Children Hospital, Sheikh Zayed Road, Dubai, UAE
2 Consultant Colorectal Surgeon, Laparoscopic Surgeon, VPS Burjeel Hospital, Abu Dhabi, UAE
3 Radiologist, Medcare Women and Children Hospital, Sheikh Zayed Road, Dubai, UAE
4 MD, FRCR, Specialist Radiologist, Medcare Women and Children Hospital, Sheikh Zayed Road, Dubai, UAE
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Charles B Nagy
Medcare Women and Children Hospital, Sheikh Zayed Road, Dubai,
UAE
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Article ID: 101409Z01CN2023
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Nagy CB, Papp S, Eldin NA, El-Maadawy SM. Extrauterine adenomyomas managed by laparoscopic excision: Three case reports with different theories of origin. Int J Case Rep Images 2023;14(2):46–52.ABSTRACT
Introduction: We present three case reports of extrauterine adenomyoma (recto-vaginal/retro-cervical, broad ligament, abdominal). The common presenting symptoms in our patients were pelvic pain, dysmenorrhea, and deep dyspareunia. The cases were successfully treated with laparoscopic excision by a multidisciplinary team of doctors. One patient showed adenomyoma co-existing with endometriosis on histopathological examination of the tissue sample.
Case Series: We present 3 cases of extra uterine adenomyomas in 3 different sites, each case representing a different theory of origin and all cases managed laparoscopically with successful outcome without any complications. First case represent the implantation theory following antecedent myomectomy. Second case represents origin of adenomyoma as direct extension from the uterus with background of severe diffuse adenomyosis. Third case represents origin from Müllerian remnants in the recto-vaginal septum with no adenomyosis or obliteration of the pouch Douglas.
Conclusion: We propose the theory that adenomyoma which is a form of adenomyosis should be regarded as a form of deep endometriosis involving the uterus rather than a separate entity. We believe that multidisciplinary laparoscopic treatment is the way forward for accurate diagnosis and treatment of adenomyosis in patients requiring to preserve fertility. Future research needs to focus on studying endometriosis behavior and recurrence according to the tissue host to understand the disease and tailor the management according to patient symptoms.
Keywords: Endometriosis, Extrauterine adenomyoma, Infertility, Laparoscopy
SUPPORTING INFORMATION
Author Contributions
Charles B Nagy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Szabolcs Papp - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nesreen Alaa Eldin - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Samar M El-Maadawy - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Charles B Nagy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
