title: Laparoscopic management of juvenile cystic adenomyoma: four cases.
abstract: OBJECTIVE
  To highlight a recently identified rare cause of severe dysmenorrhea in young patients with poor response to medical management.
  
  
  METHODS
  Evidence obtained from several timed series with or without intervention (Canadian Task Force classification II-3).
  
  
  METHODS
  Tertiary care referral hospital.
  
  
  METHODS
  Four young (age, 16-24 years) nulliparous patients with juvenile cystic adenoma with severe secondary dysmenorrhea with poor response to medical management.
  
  
  METHODS
  Laparoscopic resection of the cystic adenomyoma.
  
  
  RESULTS
  Complete resection of the cystic adenomyoma was performed laparoscopically in all patients. The lesion was uncapsulated (unlike myoma) and locally defined to the uterine myometrium (unlike diffuse adenomyosis), and there was chocolate-colored blood in the cavity. No other müllerian anomaly was observed in any patient. Histopathologic analysis revealed features suggestive of adenomyosis in all cases. After surgery, dysmenorrhea resolved completely in all patients. Compared with preoperative visual analog scores, significant improvement was observed at the first menstrual cycle after surgery. Patients are being followed up every 3 months for a minimum of 12 months to detect development of dysmenorrhea or any other menstrual disorder.
  
  
  CONCLUSIONS
  Juvenile cystic adenomyosis is a rare cause of severe dysmenorrhea. However, it should be included in the differential diagnosis in patients with dysmenorrhea with poor response to medical treatment. All patients reported in the literature and in our series were younger than 30 years, which can be considered as an arbitrary cutoff point to differentiate juvenile from adult cystic adenomyosis. It can be considered a new type of müllerian anomaly that manifests as a noncommunicating accessory uterine cavity lined with endometrium and with an otherwise normal uterus. Surgery is the only therapeutic option for these patients. Minimally invasive surgery in expert hands is advisable to preserve fertility.
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India. kriplanialka@gmail.com
authors.forename: Alka
authors.initials: A
authors.lastname: Kriplani
authors.forename: Reeta
authors.initials: R
authors.lastname: Mahey
authors.forename: Nutan
authors.initials: N
authors.lastname: Agarwal
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhatla
authors.forename: Rajni
authors.initials: R
authors.lastname: Yadav
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Singh
mesh_terms: D018194:Adenomyoma / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery*; D055815:Young Adult