Novel application of transcervical radiofrequency ablation for symptomatic cystic adenomyosis. Case report

Cystic adenomyosis is a rare subtype of adenomyosis characterized by cystic lesions within the myometrium, causing significant dysmenorrhea and pelvic pain. Traditional surgical treatments, such as laparoscopic or hysteroscopic excision, can be challenging, particularly with deep intramyometrial lesions, and risk uterine tissue trauma potentially impairing future fertility. We report the first known case of symptomatic cystic adenomyosis successfully treated using transcervical intrauterine ultrasound-guided radiofrequency ablation (RFA). A 35-year-old woman with severe dysmenorrhea, hypermenorrhea, and a 2.5 cm cystic adenomyotic lesion located deeply within the anterior myometrium underwent combined transcervical RFA (Sonata System) and laparoscopic excision of superficial peritoneal endometriosis. Real-time intraoperative ultrasound enabled safe and precise ablation with minimal myometrial injury. Six-month postoperative follow-up demonstrated complete resolution of the cystic adenomyosis and significant symptomatic relief, with only minimal residual scar tissue. Compared to conventional surgical methods, transcervical RFA offered substantial advantages including minimal invasiveness, preservation of uterine architecture, rapid recovery, and fertility preservation. This case highlights transcervical RFA as a promising, uterus-sparing therapeutic approach for managing complex cystic adenomyosis lesions, especially beneficial for women desiring future pregnancy. Further studies are warranted to evaluate long-term outcomes and broader applicability.