Extrauterine adenomyomas managed by laparoscopic excision: Three case reports with different theories of origin

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.