Abscess in Adenomyosis Mimicking a Malignancy in a54‐Year‐Old Woman

Abstract

Background:Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95´85 mm leiomyoma-like lesion including a 53´43 mm cystic space and 9´6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. Conclusion:The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.

Complications and outcomes of pregnant women with adenomyosis in Japan

“…The functional changes that occur as a result of adenomyosis during pregnancy and after delivery include decidualization and hemorrhage within the adenomyosis. As adenomyosis is characterized by a chronic inflammatory disease, it could be responsible for severe infection and abscess formation within the adenomyotic foci . The present results show an increase in the incidence of intrauterine infection (7.3%; 19/262) in pregnant women with adenomyosis.…”

Complications and outcomes of pregnant women with adenomyosis in Japan

“…As adenomyosis is characterized by a chronic inflammatory disease, it could be responsible for severe infection and abscess formation within the adenomyotic foci. 25,26 The present results show an increase in the incidence of intrauterine infection . [27][28][29][30] In the present study, there were no data to suggest that conservative surgery as a pretreatment for adenomyosis before pregnancy reduced the incidence of pregnancy complications.…”

Abscessed Uterine and Extrauterine Adenomyomas with Uterus-Like Features in a 56-Year-Old Woman

“…The uterine and extrauterine adenomyomas were abscessed in our case. Although abscess formation is reported in the endometriomas [3, 4], only Erguvan et al reported an abscessed adenomyosis [5]. In Martino et al's case the abscess occurred iatrogenically following fine needle aspiration [3].…”

“…The downgrowth and invagination of the basalis endometrium into the myometrium are the current developmental theory [2]. Although there are few reports describing abscess formation in endometriosis, there is only one reported case of abscessed adenomyosis [3–5]. Adenomyomas may be located within the myometrium, or it may involve or originate in the endometrium and grow as a polyp [1, 6].…”