See related editorial, page 385
Case notes
A 45-year-old woman underwent a robotic-assisted supracervical hysterectomy with morcellation and lysis of adhesions for dysfunctional uterine bleeding and anemia. No abdominal or pelvic lesions were noted outside the uterus. The surgical specimens weighed >800 g, and pathologic evidence suggested adenomyosis and fibroid tumors. One and one-half years after surgery, the patient experienced persistent left lower quadrant pain and lost 20 lb over 3 months. Colonoscopy was unremarkable. Computed tomography showed peritoneal masses that were suspicious for carcinomatosis. Aspiration cytologic evaluation of a cystic lesion was not diagnostic with 16-mL black syrupy liquid. Over a 3-month period, the serum CA-125 level rose from 27.5-98 U/mL, and the CA19-9 level was also elevated (39 unified atomic mass unit/mL). Whole-body positron emission tomography/computed tomography with F18-fluoro-2-deoxy-D-glucose (FDG) demonstrated 5 mostly cystic lesions mixed with solid masses or nodules both with and without abnormal uptake in the left abdomen and pelvis ( Figures 1-3 ), suspicious for peritoneal disease or carcinomatosis. The patient underwent laparoscopic resection of lesions that ranged in size from 3.5 × 2.8 × 2.0 cm to 5.5 × 4.5 × 3.0 cm that were located in the splenic flexure, omentum under the transverse colon, left lower quadrant, and anterior left pelvis. Surgical pathologic evidence revealed adenomyosis with smooth muscle hyperplasia in all lesions.
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