Uterus: Adenomyosis

A 45 yr old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months.

1.    What are differential diagnoses?

Fibroids.

Endometriosis.

Adenomyosis.

Endometrial polyp.

Dysfunctional uterine bleeding.

2.    Describe the histological features of this condition.

Islands of endometrial tissue (glandular and stromal components) within the myometrium, separated from the endometrium

3.    How do you distinguish it from endometrial adenocarcinoma invading the myometrium?

Adenomyosis:

      Presence of both glandular and stromal components

      Benign, well-differentiated glands

Adenocarcinoma of endometrium:

      Presence of glandular component only

      No stroma

      Glands are malignant, lined by stratified columnar epithelium

4.    Why should there be heavy menstrual flow?

Nests of endometrial tissue within myometrium are sometimes subjected to hormonal influence, resulting in endometrial shedding during menstruation.

5.    What is the relationship of the condition to hormones?

The endometrial tissues are sometimes responsive to ovarian hormones and undergo cyclic changes and menstruation (basal type of endometrial tissue are not responsive to ovarian hormone)

6.    What is endometriosis?

Endometriosis is the presence of endometrial tissues (gland and stroma) in abnormal locations outside the uterus

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Copyright � Joseph Ong 2003