Adenomyosis

Clinical History

A 32-year-old female patient was being studied because of a primary infertility.

Imaging Findings

A 32-year-old female patient was being studied because of a primary infertility. She was referred to our department in order to perform a hysterosalpingography that showed the presence of a small cavity projecting off the fundic portion of the uterine cavity compatible with adenomyosis.

Discussion

Adenomyosis is defined as the presence of ectopic endometrial tissue and stroma in the uterine miometrium which induces an overgrowth of the surrounding uterine smooth muscle. It is classified into focal and diffuse forms. Pathologically, a diverticular-like collection of ectopic endometrial glands and stroma is seen, which usually communicates with the uterine cavity. Smooth muscle hypertrophy commonly surrounds the area of adenomyosis. A solitary, tumour-like mass, called an adenomyoma, occurs rarely and may mimic a submucosal myoma. Adenomyosis affects women in their late reproductive years (35 – 50 years), and presents as abnormal uterine bleeding, dysmenorrhoea, or occasionally as infertility. Uterine enlargement is not uncommon, and may be a result of associated muscular hypertrophy, or more likely of the joint presence of leiomyomas. The presence of single or multiple focal cavities within the uterine wall is the most common radiographic appearance of adenomyosis in hysterosalpingography. These cavities are usually small and often look reticulated, owing to their pathological nature. On ultrasound, adenomyosis may be demonstrated with one or more of the following signs: a) ill-defined myometrial mass, b) asymmetrically thickened myometrial wall, or c) areas of heterogeneity or decreased echogeneity of the myometrium. MR T2-weighted images show a relatively homogeneous, low intensity mass, but the signal intensity is not as low in intensity as in the case of leiomyomas. There may be sparse, small, high intensity foci within an adenomyoma on T1 and T2 weighted images, which represent haemorrhage in endometrial islands. Other areas that are bright on T2 weighted images but are not seen on T1 weighted images represent small foci of no haemorrhagic endometrial tissue.

Differential Diagnosis List

Final Diagnosis

Adenomyosis.

URL:	https://eurorad.org/case/3223
DOI:	10.1594/EURORAD/CASE.3223
ISSN:	1563-4086