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. PATIENT(S): 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. INTERVENTION(S): Abdominal and pelvic computed tomography, transvaginal ultrasonography, pelvic magnetic resonance imaging, operative laparoscopy, and excision of a juvenile cystic adenomyoma (JCA). MAIN OUTCOME MEASURE(S): Resolution of the pelvic pain and restoration of normal uterine anatomy after appropriate intervention RESULT(S): 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. CONCLUSION(S): 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.