Kwon YS, et al. J Gynecol Oncol. 2009 Mar;20(1):44-47. https://doi.org/10.3802/jgo.2009.20.1.44

Although adenomyomectomy for fertility-sparing is an expanding procedure worldwide, there is no guideline or consensus about how to manage the pregnant women who have previously received conservative surgery for adenomyosis. The aim of this study is to evaluate antenatal care and delivery outcomes in pregnant women after adenomyomectomy. Between May 2011 and May 2019, the medical record was reviewed in all delivery of pregnant women received adenomyomectomy performed by a single surgeon by a uniform surgical technique. The evaluating parameters consisted of antenatal care outcomes, delivery outcomes, intrapartum outcome, and neonatal outcomes. Twenty-two patients were evaluated to monitor pregnancy and delivery outcomes after the adenomyomectomy. Mean age of delivery was 37.0 years old (SD = 3.1, range 32-45, median 37). All were delivered by cesarean section. Mean gestational age was 36.2 weeks (SD = 3.6, range 27.4-39.4, median 37.3). The mean birth weight was 2560.9 g (SD = 771.8, range 1100-3920, median 2550) and the number of preterm births admitted for prematurity care was seven (31.8%, 7/22). Placental abnormality was found in the four cases, which included two placenta accreta and two previa. However, there were no cases of hysterectomy or intervention. We identified one case of uterine rupture during pregnancy (4.5%, 1/22) at 27 weeks of gestation. Except for preterm birth, adverse neonatal outcomes were not found in this study. Delivery of pregnant women who received adenomyomectomy can obtain safe perinatal outcomes under close monitoring of preterm labor and surveillance of catastrophic pregnancy related complications.

The aim of this study was to evaluate the clinical and pathologic features of a rare tumor (adenoma malignum, AM). We retrospectively analyzed the medical records of 18 patients diagnosed with AM at a single institute between March 1992 and November 2009. The median age of the patients was 45.8 years (range 29–76 years) and the mean follow-up period was 49.2 months (range 4–168 months). A preoperative cytologic diagnosis (Papanicolaou smear) of AM was made in 22.2% (4/18) of the cases. Ten (55.6%) of the 18 patients were misdiagnosed with other benign diseases and underwent hysterectomies, which confirmed AM. Sixteen patients with AM were in the early stage (IB1, 11/18; IB2, 5/18) and the other two patients were in the advanced stage. Fourteen of 18 patients (77.8%) had pure AM alone. Adjuvant therapy was administered to eight of the patients (44.4%) with AM. The recurrence rate was zero, but the disease progressed in two of the patients (11.1%), who died of the disease. The 5-year survival rate was 88.8%. A cytological diagnosis of AM based on a Papanicolaou smear is rarely made; a deep biopsy (cone biopsy or endocervical curettage) is necessary to diagnose this rare tumor preoperatively when there is any clinical suspicion of AM.

The aim of this study is to evaluate the clinical outcomes of conservative adenomyomectomy with TOUA for diffuse uterine adenomyosis and to determine the feasibility and safety. One hundred and sixteen patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and March 2016. Surgical outcomes included operative time, intraoperative injury and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 7‐month follow‐up visit after the operation. The mean age of patients was 37.49 years (range: 26–49). The mean total surgical time was 116.12 min (range: 60–300, SD: 37.27). The mean estimated blood loss was 207.22 mL (range: 30–1200, SD: 161.08) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean duration of hospital stay was 5.05 days (range: 4–7, SD: 0.68) and the mean follow‐up period of 16.67 months (range: 6–49, SD: 12.77). At the 7‐month follow‐up after adenomyomectomy with TOUA, dysmenorrhea and menorrhagia were improved in 100% and 89% of the patients, respectively. In patients with diffuse uterine adenomyosis, even when the whole uterus is involved, for relief of severe adenomyosis‐related symptoms, adenomyomectomy with TOUA could be a safe and effective surgical treatment option for those who want to preserve their fertility.