case_images: PMC11638508_01
case_images: Findings in case 1. (a) Preoperative T2-weighted sagittal magnetic resonance image. The arrow indicates cysts within the myometrium showing high signal intensity. The uterus has diffused adenomyosis. The scale bar indicates 1 cm. (b) Laparotomy findings. The arrow indicates a cystic lesion within the myometrium. When the cyst was ruptured, the contents of the abscess spilled out. (c) Postoperative laparotomy findings. (d) Hematoxylin and eosin staining of the specimen. Infiltration of neutrophils and macrophages, and granulomatous inflammation were observed (x4). (e) Postoperative T2-weighted sagittal magnetic resonance image. The scale bar indicates 1 cm.
case_images: JOG-51-0-g001.jpg
case_images: PMC11638508_01_JOG-51-0-g001.jpg
case_images: jog16185-fig-0001
case_images: MRI re-examination suggested the presence of a 55 x 48 x 38-mm cyst and 24 x 16 x 12-mm cyst in the anterior wall (Figure 1a). The greenish-white abscesses within the cystic lesions were drained when the lesions were incised (Figure 1b). The anterior and posterior walls were closed with double-layer interrupted sutures, and the fundus was closed with triple-layer interrupted sutures, using 0-vicryl (Figure 1c). Histopathological examination revealed uterine adenomyosis with degeneration, abscess formation, and granulomatous inflammation (Figure 1d). Ten months postoperatively, we assessed a pelvic MRI and determined that it was safe for the patient to restart fertility treatments (Figure 1e).
case_images: PMC11638508_02
case_images: Findings in case 2. (a) Preoperative T2-weighted sagittal magnetic resonance image. The arrow indicates cysts within the myometrium showing high and low signal intensities. The uterus has diffused adenomyosis. The scale bars indicate 1 cm. (b) Hematoxylin and eosin staining of the specimen. Infiltration of neutrophils and macrophages, and granulomatous inflammation were observed (x4). (c) Postoperative T2-weighted sagittal magnetic resonance image. The scale bar indicates 1 cm.
case_images: JOG-51-0-g002.jpg
case_images: PMC11638508_02_JOG-51-0-g002.jpg
case_images: jog16185-fig-0002
case_images: On admission, MRI revealed a 42 x 42 x 35-mm cyst and 20 x 19 x 17-mm cyst in the fundus and posterior wall of the uterus, respectively, and diffuse uterine adenomyosis of the posterior wall (Figure 2a). The results of the culture test of the abscess showed that nothing was cultured; however, the cysts were abscesses with no epithelial lining and lined with neutrophils and inflammatory cells, indicating granulomatous inflammation (Figure 2b). We performed MRI and a hysteroscopy to check the postoperative uterus and provided permission to conceive 6 months after the operation (Figure 2c).