PMC4353969_01
T2-weighted contrast- enhancement MR imaging showing the two hypointense signal inside the antero-lateral and right-sided myoma (white arrows).
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T2-w (weighted) images (Fig. 1). Therefore, MRI diagnosis was subserosal myomas with marked central necrosis in one (the anterolateral one).
Laparoscopic finding of the uterus (U) with the antero-lateral and the posterior myoma.
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Ancillary 10 mm lateral port was then placed to the left while two others 5 mm ports were inserted centrally and to the right under direct laparoscopic guidance (Fig. 2).
Laparoscopic finding at the time of morcellament of the "core" of the antero-lateral myoma. The spillage of "chocolate colored" fluid is clearly seen.
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At the time of the morcellament of the "core" of the anterolateral myoma, a "chocolate colored" fluid spillage was noted (Fig. 3; Video S1).
Pathology. Diagnostic patterns of adenomyosis are demonstrated: endometrial glands and stroma intermixed with smooth muscular fibers (left-hand and upper side). Smooth muscle fibers (SMF) are more prominent with no glandular structures (left and bottom side). The glands are enlarged with cellular debris in the lumen (blue star, right-hand side). This histologic findings are consistent with a diagnosis of cystic adenomyosis.
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No malignant features were identified (Fig. 4).