Adenomyosis

growth of endometrial stroma and glands to the myometrium of a uterus
basic details

1. ADENOMYOSIS

2. DEFENITION Benign ingrowing of endometrium into the myometrium Both glandular and stromal components of endometrium are involved Etiology unknown

3. PATHOLOGY Uterus enlarged( myometrial hyperplasia) Asymmetrical enlargement, more on posterior wall Size not more than 12-14 weeks of a gravid uterus Cut section: thickening of uterine wall-characteristic trabeculated appearance No capsule

4. Gross photograph of uterus showing thickened endometrium (hyperplasia) with trabeculated appearance of myometrium ( adenomyosis )

5. Microscopy-glandular tissue surrounded by stromal cells in the myometrium Ectopic endometrium -separate from the underlying basal endometrium, located deeper than the endomyometrial junction by more than one HPF Response to steroids minimal- invasion mainly in the basal layer

6. CLINICAL FEATURES Usually asymptomatic, detected on routine examination Usually parous , in their forties Can coexist with endometriosis and fibroids

7. SYMPTOMS Menorrhagia(increased surface area & endometrial hyperplasia) or menometrorrhagia Congestive dysmenorrhea( cramping starts with the menstrual flow or days earlier) Some can have cramps throughout the month aggravating during the periods Deep dyspareunia premenstrually

8. SIGNS Abdominal examination- uterus enlarged( not more than 14 weeks) Pelvic examination- uniform uterine enlargement with no restriction of mobility Uterus may be softer than normal Findings altered if there is associated endometriosis

9. ULTRASOUND Enlarged uterus –asymmetrical enlargement of usually the posterior wall Myometrium – multiple small cysts, increased vascularity, heterogeneous texture Endomyometrial junction indistinct If localised, misdiagnosed for fibroids

10. MRI Widening of junctional zone- thickness 12mm or more Differentiate localised adenomyoma and fibroid- lack distinct borders and usually posterior

11. MANAGEMENT Depends on age and desire for future fertility Secondary dysmenorrhea- NSAIDS & OCPs GnRH agonists, LNG-IUS Medical management- not very effective Total hysterectomy ( parous women >40) Resection (younger women, localised adenomyosis )

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