ADENOMYOSIS
A 42-year-old woman complains of increasing pain with her menstrual
periods for the past 8 months. She also states her periods are getting
heavier, leaving her tired and weak. She underwent a postpartum tubal
ligation after her last child 10 years ago. She has been treated for chronic
hypertension for the past 3 years. On pelvic examination her uterus is 12-
week size, globular, soft, and tender. Rectovaginal examination is
unremarkable.Adenomyosis is the presence of ectopic endometrial glands and stroma located
within the myometrium of the uterine wall. The most common presentation is
diffuse involvement of the myometrium. The lesion is known as an
adenomyoma if the involvement is focal, surrounded by a pseudocapsule.
In most cases the diagnosis is made clinically by identifying an enlarged,
symmetric, tender uterus in the absence of pregnancy. The only definitive
diagnosis is by histologic confirmation of the surgically excised tissue.
Table II-4-3. Differential Diagnosis for Enlarged Nonpregnant UterusLeiomyoma Adenomyosis
Asymmetric Symmetric
Firm Soft
Nontender Tender