| Adenomyosis characteristically affects porous women over the
age of 40 years. It is related to a diffuse or focal invasion of
the myometrium by nests of endometrial tissue causing uterine enlargement.
The diagnosis of adenomyosis is suspected if the uterus feels enlarged
and tender to the touch during the pelvic examination. However,
the diagnosis of adenomyosis based on these findings is often inaccurate,
and other causes-fibroids, endometriosis, or polyps-are often found
as the cause for the bleeding or discomfort. The diagnosis may be
suggested by the appearance of the uterus on a sonogram, although
it is often difficult to tell the difference between adenomyosis
TVUS is as efficient as MRI for the diagnosis of adenomyosis in
women without myoma, while MRI could be recommended for women with
associated leiomyoma (6). The combination of MRI and TVS produced
the highest level of accuracy for exclusion of adenomyosis (7).
Adenomyosis, although considered a variant of endometriosis, is
different because of its behavior.
Adenomyosis is classified into 3 categories depending on the location
of the lesion: those limited to the basal layer, those in the deep
layers, and those in the surface layers. Iribarne et al suggest
a new category: intramyometrial cystic adenomyosis.
Pathologically, uterine adenomyosis is a condition in which the
stroma and/or heterotopic endometrial glands are located deeper
than the endometrial-myometrial junction by more than 1 high-power
field. The stratum basale of the endometrium gives rise to the heterotopic
endometrial tissue. Invasion by nests of endornetrial tissue causes
In the absence of focal fibroids, a diffuse uterine process seen
on sonography relates to the severity of adenomyosis. The visualization
of the endometrium does not relate to the severity of adenomyosis
The adenomyosis is rarely isolated. It is associated to uterine
fibroma in 62% of cases. Their symptoms and signs are often the
Adenomyosis may be asymptomatic.
symptoms : painful menses, heavy but regular bleeding, pelvic pain
(20), unresponsiveness to hormonal therapy or uterine evacuation.
Adenomyosis can cause infertility.
Pelvic sonography provides an accurate diagnosis of adenomyosis
in the majority of cases. Endovaginal US was as accurate as MR imaging
in the diagnosis of uterine adenomyosis (13).
The sensitivity and specificity of transvaginal ultrasonography
were 82 - 89 and 67- 89 % respectively (12 , 13 , 14 , 16).
The myometrial écho pattern, central écho comples and utérine contour
may he normal. Occasion-ally, adenomyosis is focal, which may result
in contour ahnormality, although the central echo complex is normal.
Rarely a honeycomb appearance caused by cystic spaces is encountered.
Pelvis endometriosis and adenomyosis may coexist in 30% of patients.
A diagnosis of adenomyosis was suggested if the uterus was diffusely
enlarged, but the myometrial texture, contour, and central cavity
echoes were each normal. Leiomyoma, or other focal uterine pathology
was characterized by focal or globular uterine enlargement with
abnormal echo texture and contour, as well as nonvisualization or
displacement of the central cavity echo complex (17).
Sonographic features used in the diagnosis of adenomyosis : a mottled
inhomogeneous myometrial texture, enlargement of the uterus and
globular appearing uterus, small cystic spaces within the myometrium,
and a "shaggy" indistinct endometrial stripe (8 , 18).
The presence of subendometrial linear striations, subendometrial
echogenic nodules, or asymmetric myometrial thickness improves the
specificity and PPV of US in diagnosing adenomyosis (9). The ultrasonographical
demonstration of endometrial cyst of the ovary may contribute to
an accurate diagnosis of adenomyosis (19).
The treatment for symptomatic adenomyosis has been hysterectomy.
Patients without or with only minimal endometrial penetration of
<2.5 mm (superficial adenomyosis) have good results from the ablation.
Patients with deep endometrial penetration of >2.5 mm (deep adenomyosis)
usually have persistent problems and should be offered hysterectomy
over repeat ablation (10). Hysterectomy will still be necessary
in severe cases of adenomyosis (11).
More conservative treatments are increasingly used to treat adenomyosis.
Gonadotropin-releasing hormone (GnRH) agonists have been used to
treat the infertility that can result from adenomyosis. Adenomyosis
also has responded to estrogen. Recently,uterine-artery embolization
may relieve the signs or symptoms of adenomyosis(2).
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A Case of Adenomyosis per se with a Uterine Weight of 475 g. Harmanli
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Temple University School of Medicine, Philadelphia, Pa., USA.
2: Clin Radiol. 2004 Jun;59(6):520-6. Uterine artery embolization
for adenomyosis without fibroids. Kim MD, Won JW, Lee DY, Ahn
CS. Diagnostic Radiology, Bundang CHA General Hospital, Pochon
CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do,
Sungnam, South Korea. firstname.lastname@example.org
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transvaginal sonography for the diagnosis of adenomyosis, with
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