Precarious preoperative diagnostics and hints for the laparoscopic excision of uterine adenomatoid tumors: two exemplary cases and literature review

Objective: To present two exemplary cases of adenomatoid tumors. Design: Case report. Setting: Two laparoscopic centers in Germany. Patient(s): Two women of reproductive age with uterine adenomatoid tumors. Intervention(s): Laparoscopic tumor excision. Main Outcome Measure(s): Differential diagnostics of uterine masses. Result(s): Intraoperatively, tumor excision is difficult because of the missing capsule that allows simple enucleation of fibroids. Adenomatoid tumors need to be cut out of the myometrium because they are densely adherent, with no clear plane of cleavage. Definite exclusion of a malignant tumor is only possible by histologic workup. Conclusion(s): The above might lead to an intraoperative dilemma in the case of young women because a malignant tumor would implicate a more radical operative strategy. Nevertheless, owing to the benign nature of adenomatoid tumors and the lack of recurrence, simple resection with conservation of the surrounding tissue is the treatment of choice. The proper laparoscopic handling of such cases is illustrated and placed in context within the existing literature. (Fertil Steril (R) 2011;95:1119.e5-e8. (c) 2011 by American Society for Reproductive Medicine.)