Abstract:

Cervical cystic adenomyoma is a rare subtype of adenomyosis. Its pathological characteristics include the formation of cystic lesions containing old hemorrhage, surrounded by smooth muscle within the cervical myometrium. The condition lacks specific clinical manifestations and often presents with refractory dysmenorrhea, pelvic pain, or menstrual irregularities. Its imaging findings are varied, making preoperative diagnosis difficult. A case of cervical cystic adenomyoma in a 24-year-old unmarried woman is reported. The patient presented with progressive dysmenorrhea for 16 months. MRI revealed a multilocular cystic lesion in the anterior cervix, with hyperintense internal content (on T2-weighted images), clear septations between cysts, and no communication with the uterine cavity. Cystoscopy combined with laparoscopic excision of the cervical lesion was performed. Chocolate-like old blood was found within the cyst. Postoperative pathological examination confirmed the diagnosis of cervical cystic adenomyoma. The patient received adjuvant therapy with a gonadotropin-releasing hormone agonist (GnRH-a) for three cycles after surgery. Follow-up at six months showed no recurrence, and dysmenorrhea was significantly relieved. The experience from this case suggests that combining preoperative MRI assessment, meticulous laparoscopic excision, and postoperative adjuvant GnRH-a therapy can safely and effectively eliminate the lesion while preserving the patient's fertility.

Key words: Cervix uteri, Cystic adenomyoma, Magnetic resonance imaging, Laparoscopy, Fertility