Uterine adenomyosis

Uterine adenomyosis, also adenomyosis of the uterus, is a relatively common benign pathology of the uterine corpus. It can be thought of as endometriosis in the uterine smooth muscle.

Uterine adenomyosis
Diagnosis in short
Uterine adenomyosis. H&E stain.
LM	at least 2 of 3: (1) endometrial glands, (2) endometrial stroma, (3) hemosiderin-laden macrophages
LM DDx	endometrioid endometrial carcinoma
Gross	globoid shape, slightly enlarged, trabeculated cut surface +/- small foci of hemorrhage
Site	uterus
Associated Dx	endometriosis (?)
Signs	menorrhagia
Symptoms	cyclic pelvic pain, dysmenorrhea
Prevalence	common
Prognosis	benign

Uterine adenomyoma redirects here.

General

• Common.
• May be a cause of bleeding.
• Dysmenorrhea - painful menses.
• Associated with endometriosis.^{[citation needed]}

Gross

Features:

• Trabeculated cut surface +/- small foci of hemorrhage.
  • Often described as "basket-weave" pattern.
• Globoid, slightly enlarged.

Note:

• May form a mass - known as adenomyoma.

Image:

• Uterine adenomyosis (flickr.com/infopathic).
• Uterine adenomyosis - close-up (flickr.com/infopathic).

Microscopic

Features:

• Endometrial glands within uterine muscle - key feature.
  • Endometrial glands:
    • Circular.
    • Simple epithelial or pseudostratified epithelium +/- mitoses.
  • +/-Surrounded by endometrial stroma.
    • Densely packed spindle cells without nuclear atypia.
  • Blood:
    • Within glands.
    • Hemosiderin-laden macrophages.

Note:

• Can be thought of as endometriosis of the myometrium.
• A large number of extent criteria exist - see extent criteria.

DDx:

• Endometrioid endometrial carcinoma.

Extent criteria

Consensus is lacking on diagnostic criteria. Focal superficial endometrial glands are generally not deemed sufficient by most.

Selected criteria

Diagnostic criterium	Category / Comment	Reference
endometrial-myometrial interface disrupted	anatomical definition
>2.5 mm myometrial invasion	measurement criterium

Abbott published a summary table of various criteria.

Images

• 

  Adenomyosis - low mag. (WC/Nephron)

• 

  Adenomyosis - intermed. mag. (WC/Nephron)

• 

  Adenomyosis - high mag. (WC/Nephron)

• 

  Adenomyosis - high mag. (WC/Nephron)

• 

  Adenomyosis - very high mag. (WC/Nephron)

• 

  Adenomyosis (WC/KGH)

Sign out

Uterus, Bilateral Fallopian Tubes, Hysterectomy and Bilateral Salpingectomy:
- Uterine adenomyosis, extensive.
- Uterine leiomyoma.
- Proliferative endometrium.
- Fallopian tubes within normal limits.
- NEGATIVE for malignancy.

Block letters

UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH ADENOMYOSIS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- PROLIFERATIVE PHASE ENDOMETRIUM.

UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH SUPERFICIAL ADENOMYOSIS.
- UTERINE CERVIX WITH PARTIAL DENUDATION, FOCUS OF ENDOMETRIOSIS AND INFLAMMATION,
  OTHERWISE WITHIN NORMAL LIMITS.
- SUPERFICIAL FIBROSIS AND HYALINE CHANGE OF THE UTERINE LINING -- COMPATIBLE
  WITH PRIOR ABLATION.

See also

• Uterus.
• Adenomyosis.