title: Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases.
abstract: OBJECTIVE
  To define diagnostic criteria for juvenile cystic adenomyoma (JCA), describe the histologic features of the condition and evaluate laparoscopic excision for treating associated dysmenorrhea and pelvic pain.
  
  
  METHODS
  Prospective long-term follow-up study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Nine consecutive patients with JCA.
  
  
  METHODS
  Patients meeting the diagnostic criteria for JCA underwent laparoscopic enucleation of the lesion. The severity of dysmenorrhea was evaluated before surgery and every 6 months after surgery. Five patients underwent second-look laparoscopy (SLL) 6 months after surgery.
  
  
  METHODS
  Relief of dysmenorrhea as measured by a visual analog scale, postoperative healing at SLL, and subsequent pregnancy when desired by the patient.
  
  
  RESULTS
  Laparoscopic enucleation of the cystic adenomyoma resulted in a statistically and clinically significant reduction in dysmenorrhea and improved chronic pelvic pain. Neither cystic adenomyoma nor severe dysmenorrhea recurred during the follow-up period. Adhesions were minimal at SLL. Two of the three patients who desired pregnancy conceived after surgery. The histologic findings of the JCA lesion and adenomyosis were similar, and the endometrial glands and stroma infiltrating the surrounding myometrium in all patients were consistent with the appearance of adenomyosis.
  
  
  CONCLUSIONS
  We defined the diagnostic criteria for JCA, and demonstrated significant improvement of dysmenorrhea after laparoscopic excision of the lesion.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. hirotake@med.juntendo.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Keiji
authors.initials: K
authors.lastname: Kuroda
authors.forename: Makoto
authors.initials: M
authors.lastname: Jinushi
mesh_terms: D018194:Adenomyoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D003560:Cysts / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D010535:Laparoscopy; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult