3 s2.0 B9781437737943000013 3 PDF
3 s2.0 B9781437737943000013 3 PDF
3 s2.0 B9781437737943000013 3 PDF
Adenomyosis
Synonyms/Description
Endometriosis of the uterus or myometrium
Etiology
Adenomyosis is defined pathologically when
endometrial glands and stroma are found in the
myometrium, distant from the endometrial cavity itself. This ectopic endometrial tissue has the
ability to induce hypertrophy of the surrounding
myometrium. This process can be focal or diffuse
and thus accounts for the variability in the ultrasound appearances noted. The endometriummyometrium junctional zone is jagged and fuzzy
because the endometrial mucosa essentially
invades the underlying myometrium, thus blurring the interface between these two, typically
distinct zones. (This may be focal or global.)
Differential Diagnosis
If the area of adenomyosis is focal, it may be confused with a fibroid or a polyp if it projects into
the endometrial cavity. Because of the lucencies
and heterogeneities in the myometrium, uterine
malignancy (though very rare) is sometimes considered. The clue to the correct diagnosis is the
asymmetry of the width of the myometrium
comparing the posterior to the anterior aspect
on longitudinal view as well as the shaggy
appearance of the endometrial echo in a patient
with chronic pain and abnormal bleeding.
Adenomyoma
Historically, heavy menstrual bleeding (menorrhagia) and painful menstruation (dysmenorrhea) are the major symptoms of adenomyosis
and are said to occur in approximately 60% and
25% of women, respectively. It has also been
implicated in some cases of chronic pelvic pain.
In the past, symptoms typically developed in
women in the fourth and fifth decade of life
(perimenopausally); however, this probably
reflects the fact that in the past the diagnosis of
adenomyosis historically was made at the time
of hysterectomy and not with sophisticated
Ultrasound Findings
Generalized Adenomyosis
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Section 1
Adenomyosis
Figure A1-1 Two different patients. Typical appearance of the myometrium, which is asymmetric because of
adenomyosis. Note that the endometrial echo is closer to the anterior than the posterior wall of the uterus.
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Adenomyosis
Figure A1-2 Heterogeneous myometrium containing small echolucencies, typical of adenomyosis (two different
patients).
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Figure A1-3 Adenomyoma projecting into the endometrial cavity from a broad base within the myometrium.
A shows the mass as ill-defined within the cavity, worrisome for a malignancy, especially in a postmenopausal patient.
B from the same patient shows the sonohysterogram with saline outlining the adenomyoma diagnosed by pathology.
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Section 1
Adenomyosis
Figure A1-4 Three-dimensional ultrasound of two different patients with extensive adenomyosis. A shows the
reconstructed coronal view of the uterus with a fuzzy, ill-defined junction and linear echogenicities emanating out
from the edges of the endometrium. B shows a different patient with adenomyosis and a right-sided fibroid
demonstrating similar echolucencies. C (same patient as B) shows the inverse mode of the 3-D image that accentuates the lack of a clear border at the junction of the endometrium and myometrium.
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Section 1
Adenomyosis
Suggested Reading
Bocca SM, Oehninger S, Stadtmauer L, Agard J,
Duran EH, Sarhan A, Horton S, Abuhamad AZ.
A study of the cost, accuracy, and benefits of
3-dimensional sonography compared with hysterosalpingography in women with uterine abnormalities. J Ultrasound Med. 2012;31:81-85.
Champaneria R, Abedin P, Daniels J, Balogun M,
Khan KS. Ultrasound scan and magnetic resonance
imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet
Gynecol Scand. 2010;89:1374-1384.
Exacoustos C, Brienza L, Di Giovanni A, Szabolcs B,
Romanini ME, Zupi E, Arduini D. Adenomyosis
three-dimensional sonographic findings of the
junctional zone and correlation with histology.
Ultrasound Obstet Gynecol. 2011;37:471-479.
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For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.