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Adenomyosis
- 1. ADENOMYOSIS
- 2. DEFENITION • Benign ingrowing of endometrium into the myometrium • Both glandular and stromal components of endometrium are involved • Etiology unknown
- 4. 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
- 5. Gross photograph of uterus showing thickened endometrium (hyperplasia) with trabeculated appearance of myometrium (adenomyosis)
- 6. • 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
- 9. CLINICAL FEATURES • Usually asymptomatic, detected on routine examination • Usually parous , in their forties • Can coexist with endometriosis and fibroids
- 10. 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
- 11. 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
- 12. 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
- 14. MRI • Widening of junctional zone- thickness 12mm or more • Differentiate localised adenomyoma and fibroid- lack distinct borders and usually posterior
- 16. 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)
- 17. THANK YOU