To explore the clinical manifestations, diagnosis and treatment methods of patients with uterine cystic adenomyoma (UCA).

A patient with spontaneous rupture of UCA who was treated at the Chengdu First People′s Hospital in June 2023 (patient 1) was selected as the subject. A retrospective analysis method was used to collect the patient′s examination results after admission, main treatment process, pathological examination and follow-up results. Keywords such as " uterine cystic adenomyoma" " uterine adenomyosis cyst" " cystic adenomyoma" " adenomyotic cyst" " uterine adenomyoma" in both Chinese and English were used to retrieve literature related to UCA from CNKI, Wanfang Data Knowledge Service Platform, VIP Chinese Science and Technology Journal Database, and PubMed literature databases. The literature search time was set from the establishment of the above databases to August 31, 2024. The procedures followed in this study were in accordance with the requirements of Helsinki Declaration of the World Medical Association revised in 2013.

①Patient 1, a 38-year-old woman (G₁P₁), had a history of cesarean delivery. Her menstrual cycle was regular, without dysmenorrhea, and her last menstruation started on June 25, 2023. On June 28, 2023, she was admitted to emergency department of our hospital due to " sudden lower abdominal pain, continuous colic, with nausea and vomiting". And the pain was relieved after treatment. On June 30, 2023, follow-up at our hospital′s gynecology outpatient clinic showed significant pain relief, but transvaginal color Doppler ultrasound indicated abnormalities. She was hospitalized in our hospital on July 3, 2023. Enhanced abdominal CT after admission revealed abnormal uterine morphology, uneven enhancement, a 4.5 cm × 4.4 cm × 4.5 cm mass posterior to the uterus, poorly defined, suggesting a uterine tumor. The initial diagnosis upon admission was pelvic mass, suspected adnexal mass, intestinal tumor, or sacral tumor. On July 6, 2023, single-port laparoscopy and UCA resection were performed. Intraoperatively, old hemorrhage and a 5 cm × 5 cm × 4 cm uterine mass near the posterior cervix were found, containing a chocolate-like cystic lesion. Based on medical history, clinical presentation, auxiliary tests, surgery, and pathological examination results, patient 1 was diagnosed with ruptured UCA. After the operation, she was treated with leuprorelin and long-term oral administration of dienogest. The results of vaginal ultrasound about 2 years after the operation showed a uterus of 6.3 cm × 4.1 cm × 4.3 cm with multiple hypoechoic nodules, the largest (2.0 cm × 1.9 cm × 1.7 cm) in the posterior wall, with relatively clear borders but irregular shape. ②Literature review results: According to the literature search strategy set for this study, excluding cases of juvenile UCA in patients under 30 years of age, 25 articles related to adult UCA patient studies were retrieved, involving 54 UCA patients. Combining patient 1, a total of 55 UCA patients were studied. The median age of these 55 patients was 38.6 years; 14 patients (25.5%) had clinical symptoms of prolonged menstruation, increased menstrual flow with abdominal pain, 11 patients (20.0%) had progressively severe dysmenorrhea, 17 patients (30.9%) had irregular vaginal bleeding, 7 patients (12.7%) had acute abdominal pain or chronic pelvic pain, and 6 patients (10.9%) had pelvic or uterine cavity mass. Only 12 patients (21.8%) were preoperatively diagnosed with UCA, while the other 43 patients (78.2%) were misdiagnosed, and all 55 cases were diagnosed as UCA by histopathological examination. And 47 patients (85.5%) underwent surgical treatment, 7 patients underwent ultrasound-guided puncture, and 1 patient underwent conservative treatment. After treatment, the above clinical symptoms were relieved.

UCA is difficult to diagnose preoperatively and is easily misdiagnosed. It needs to be diagnosed based on the patient′s clinical manifestations, imaging examinations, and pathological examinations. Surgery is the main treatment method with a relatively good prognosis.