A 45 years old female patient presents with abdominal discomfort. On pelvic examination, there is enlargement of uterus with absence of nodularity. She is sexually active and uses contraception. Biopsy revealed extension of endometrial glands to the myometrium. The most accurate diagnosis is
Answer: a) Adenomyosis.ADENOMYOSIS (Uterine Endometriosis)/ diffuse endometriosis internaPresence of functioning endometrial glands and stroma in the myometrium.Normal endometrial glands grow into the myometrium.Myometrial cells around become hypertrophy and hyperplasia compensativelyProposed by Cullen in 1908, the theory of direct growth of the basal layer of endometrium into the myometrium is widely accepted.M/c site: body of uterus (corpus)More common among multipara, over the age of 35 years.Etiology: repeated child birth, uterine scarringRare to involve cervix, rare in nulliparaEstrogen has been implicated as a stimulus to the development of adenomyosis.The symptomatic improvement that occurs with the onset of menopause supports this concept.Microscopic criteria:Presence of endometrial glands and stroma in the midst of the myometriumIn atleast 2 low power fieldsBeyond the endometrial-myometrial junction2.5mm beneath the basal layer of endometrium.Symptoms:Hypermenorrhea (menorrhagia) 50%Dysmenorrhea 30%Symmetrically enlarged uterus (does not enlarge > 14 weeks size)Classical examination findings include a tender, symmetrically enlarged uterus without adnexal tenderness.Improved ultrasound (most routinely done investigation): preoperative diagnosisMRI (gold standard investigation): negative/equivocal sonogramTreatment of choice for Adenomyosis: total hysterectomy (no role of medical management).
Adenomyosis
Endometriosis
Leiomyomatosis
Endometrial hyperplasia
Miscellaneous (Gynae)