Uterine adenomyosis

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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 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 adenomyoma redirects here.

General

Gross

Features:

  • Trabeculated cut surface +/- small foci of hemorrhage.[3]
    • Often described as "basket-weave" pattern.
  • Globoid, slightly enlarged.[4]

Note:

Image:

Microscopic

Features:

  • Endometrial glands within uterine muscle - key feature.
    • Endometrial glands:
      • Circular.
      • Simple epithelial or pseudostratified epithelium +/- mitoses.
    • +/-Surrounded by endometrial stroma.
    • Blood:
      • Within glands.
      • Hemosiderin-laden macrophages.

Note:

DDx:

Images

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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

References

  1. Reinhold, C.; Tafazoli, F.; Mehio, A.; Wang, L.; Atri, M.; Siegelman, ES.; Rohoman, L. (Oct 1999). "Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.". Radiographics 19 Spec No: S147-60. PMID 10517451.
  2. Cockerham, AZ.. "Adenomyosis: a challenge in clinical gynecology.". J Midwifery Womens Health 57 (3): 212-20. doi:10.1111/j.1542-2011.2011.00117.x. PMID 22594861.
  3. Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 432. ISBN 978-0-323-06516-0.
  4. HUNTER, WC.; SMITH, LL.; REINER, WC. (Apr 1947). "Uterine adenomyosis; incidence, symptoms, and pathology in 1,856 hysterectomies.". Am J Obstet Gynecol 53 (4): 663-8. PMID 20291238.
  5. Tahlan, A.; Nanda, A.; Mohan, H. (Oct 2006). "Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature.". Int J Gynecol Pathol 25 (4): 361-5. doi:10.1097/01.pgp.0000209570.08716.b3. PMID 16990713.