Hysteroscopic treatment of submucous cystic adenomyosis

Adenomyosis is a benign condition characterized by the presence of endometrial glands and stroma invading the myometrium with the presence of hyperplasia and hypertrophy of the smooth muscle fibers. It occurs mostly in women between the fourth and fifth decade of life, associated risk factors are multiparity, previous uterine surgery and presence of endometriosis; and like the latter, it is also estrogen sensitive.

Two forms of presentation are described focal and diffuse. Focal adenomyosis may occur as a well circumscribed nodular lesion (adenomyoma), similar to an intramural fibroid or restricted to one uterine wall structure in the form of localized adenomyosis. By contrast, the diffuse form is one in which can affect the entire uterus without demarcated boundaries between invaded tissue and surrounding healthy myometrium.

With the use of modern improved imaging techniques, authors have described a growing number of cases in adolescents and young adult women with dysmenorrhea, emerging a new type of adenomyosis called “cystic”. At present, the diagnosis is mainly based on MRI, presenting as a cystic structure with an internal diameter ≥10 mm and hemorrhagic content surrounded by myometrial tissue. In a review of cystic adenomyosis, Brosens et al (2015) described three types (A, B, and C) with their respective subtypes, according to the location of the cyst and the complexity of the lesion

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