Uterus
Non tumor
Adenomyosis

Author: Irem Onur, M.D. (see Authors page)
Editor: Ayse Ayhan, M.D., Ph.D.

Revised: 24 October 2016, last major update October 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Uterine adenomyosis
Cite this page: Adenomyosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusadenomyosis.html. Accessed December 3rd, 2016.
Definition / General
  • A nonneoplastic lesion of myometrial tissue characterized by the presence of endometrial glands and stroma within myometrium (Best Pract Res Clin Obstet Gynaecol 2006;20:511)
  • Synonyms: myometrial endometriosis, superficial adenomyosis (1 - 2.5 mm in myometrium), stromal adenomyosis, incomplete adenomyosis, adenomyosis with sparse glands
  • Usually an incidental finding in hysterectomy specimens (Int J Gynecol Pathol 1996;15:217)
  • May be diffuse or focal
  • May be involved by hyperplasia and carcinoma
ICD-10 coding
  • N80.0
Epidemiology
Sites
  • Frequently in posterior, less commonly in anterior uterine wall
  • Rarely in cornua or by cervical os
Pathophysiology
Etiology
  • Adenomyosis and endometriosis are usually regarded as closely related, but
    • Microscopic appearance, and probably their pathogenesis, are somewhat different
    • They may occur independently of each other
    • Adenomyosis mostly is made up of nonfunctional (basal) endometrium and is frequently connected with the mucosa (vs. endometriosis, composed of functional layers)
    • Adenomyosis may represents a unique form of endometrial diverticulosis
  • Hypothetical mechanisms include (Crum: Diagnostic Gynecologic and Obstetric Pathology, 2nd Edition, 2011)
    • Instillation of endometrium within the myometrium
    • In situ metaplasia of pluripotent stem cells retained in myometrium or
    • Improper partitioning of the endometrium from the myometrium
  • Of note, del(7) (q21.2q31.2), a deletion found in typical leiomyoma, has been found in three cases of adenomyosis, suggesting some pathobiologic overlap between leiomyomata and adenomyosis (Cancer Genet Cytogenet 1995;80:118)
  • Definitive distinction between these explanations requires further study
Clinical Features
Diagnosis
  • By histopathologic examination of well oriented hysterectomies
  • Essentially should not be diagnosed in curettings or hysteroscopic material
Radiology Description
Prognostic Factors
  • Benign; excellent prognosis even if not removed
Case Reports
Treatment
Gross Description
Gross Images

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Contributed by Ayse Ayhan, M.D., Ph.D.



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Thickened and spongy myometrium

Micro Description
Micro Images

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Contributed by Ayse Ayhan, M.D., Ph.D.


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Various images



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Endometrial glands and stroma

Positive Stains
Differential Diagnosis