case_images: PMC9387368_01
case_images: Suburethral lesion, approximately 2 Centimeters In diameter as seen during initial consultation.
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case_images: F1
case_images: On physical examination during her initial consultation at our center, an approximately 2 cm in diameter bluish cystic-appearing lesion was noted on the urethra and was tender (Figure 1).
case_images: Videohysteroscopic view of bluish discoloration within the myometrial wall.
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case_images: F2
case_images: Intraoperative hysteroscopic findings on day 21 of her menstrual cycle included external fundal compression of intramural mass without cavity distortion and multiple areas of bluish glandular pattern suggestive of adenomyosis. (Figure 2).
case_images: Videolaparoscopic view of uterine fundus with area of muscular hypertrophy and adenomyosis.
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case_images: F3
case_images: The uterus had posterior and fundal wall asymmetry, which upon exploration contained no capsule and was compatible with severe muscular hypertrophy and adenomyosis confirmed by frozen section. (Figure 3) Both fallopian tubes appeared to be normal and patent with injection of indigo carmine.
case_images: Scattered endometrotic lesions along rectovaginal septum and pelvic side wall.
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case_images: F4
case_images: There were scattered endometriotic lesions along the pelvic sidewalls and anterior and posterior cul-de-sac, which had slight retroperitoneal fibroadipose tissue penetration. (Figure 4) There was no evidence of deep infiltration to the retroperitoneal structures.
case_images: View of presacral space dissection and enlarged lymph node.
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case_images: F5
case_images: There was one enlarged presacral lymph node that was excised and was positive for endometriosis on frozen section (Figures 5 and 6).
case_images: Microscopic view of lymph node with endometriotic glands within.
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case_images: F6
case_images: There was one enlarged presacral lymph node that was excised and was positive for endometriosis on frozen section (Figures 5 and 6).
case_images: Microscopic view of suburethral lesion with areas of degeneration and endometriotic stroma.
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case_images: F7
case_images: The suburethral lesion was sharply excised and revealed chocolate like material and a fibrotic cyst wall to the paraurethral tissue but no urethral muscularis invasion (Figure 7).
case_images: Site of lesion at two weeks post-operative visit.
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case_images: F8
case_images: At both two and six-week postoperative visits she had progressive recovery, and the site of suburethral excision had healed. (Figure 8) The postoperative course was uneventful.