Ju UC, Kang WD, Kim SM. Adenomyosis-associated uterine rupture and pulmonary endometriosis mimicking advanced-stage uterine malignancy in an adolescent female: A case report. World J Clin Cases 2025; 13(28): 109536 [DOI: 10.12998/wjcc.v13.i28.109536]
Corresponding Author of This Article
Seok Mo Kim, MD, PhD, Professor, Department of Obstetrics and Gynecology, Chonnam National University Medical School, 8 Hakdong, Dong-gu, Gwangju 61469, South Korea. seokmokim2001@gmail.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Adenomyosis-associated uterine rupture and pulmonary endometriosis mimicking advanced-stage uterine malignancy in an adolescent female: A case report
U Chul Ju, Woo Dae Kang, Seok Mo Kim
U Chul Ju, Woo Dae Kang, Seok Mo Kim, Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju 61469, South Korea
Co-first authors: U Chul Ju and Woo Dae Kang.
Author contributions: Ju UC and Kang WD performed the research, analyzed the data, and wrote the manuscript as the co-first authors of the paper; Kim SM provided help and advice on the data analyzation; Ju UC, Kang WD, and Kim SM designed the research study; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seok Mo Kim, MD, PhD, Professor, Department of Obstetrics and Gynecology, Chonnam National University Medical School, 8 Hakdong, Dong-gu, Gwangju 61469, South Korea. seokmokim2001@gmail.com
Received: May 15, 2025 Revised: June 4, 2025 Accepted: July 4, 2025 Published online: October 6, 2025 Processing time: 85 Days and 6.8 Hours
Abstract
BACKGROUND
Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features, which may mimic malignancy. Here, we describe a case of adenomyosis-associated uterine rupture (secondary to hemorrhagic necrosis) and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.
CASE SUMMARY
A 16-year-old girl presented with acute abdominal pain and oliguria. Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease. Laboratory tests demonstrated severe anemia and markedly elevated tumor markers [cancer antigen (CA)-125: 1063 U/mL; CA-19-9: 1347 U/mL]. Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis, with no macroscopic abnormalities in other organs. A total abdominal hysterectomy was performed. Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis. Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis. The patient has remained disease-free under treatment with oral dienogest.
CONCLUSION
This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy, necessitating broad differential diagnoses despite alarming presentations.
Core Tip: This case underscores the considerable diagnostic challenges associated with rare presentations of uterine adenomyosis and pulmonary endometriosis in adolescent patients. The clinical overlap with malignancy underscores the need for a high index of suspicion and a multidisciplinary approach to ensure accurate diagnosis and timely intervention. As demonstrated here, early surgical management combined with appropriate postoperative medical therapy can lead to favorable outcomes, even in the context of severe and atypical diseases. This case reinforces the necessity of including benign etiologies in the differential diagnosis of presumed advanced-stage malignancies, particularly in young female patients.
