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Uterus

Non tumor

Adenomyosis


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 3 October 2011, last major update October 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Endometrial glands and stroma deep in myometrium
● Causes menorrhagia, pelvic pain during menstruation; rarely causes rupture during pregnancy
● Occurs in 15% of uteri
● May be caused by tissue injury and repair (Arch Gynecol Obstet 2009;280:529)
● May be involved by hyperplasia or carcinoma

Treatment
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● To control symptoms: uterine artery embolization (Cardiovasc Intervent Radiol 2011 Aug 18 [Epub ahead of print]), D&C, hysterectomy

Gross description
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● Numerous small cysts in enlarged and globular uterus, associated with myometrial hypertrophy and trabeculated smooth muscle
● Cannot be shelled out
● In elderly women, uterus may appear atrophic

Gross images
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Thickened and spongy myometrium

Cystic cavities correspond to adenomyosis

Micro description
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● Stroma plus marker glands deep in myometrium (at least one low power field from endomyometrial junction, which is usually irregular)
● Often smooth muscle hypertrophy present around glands
● Usually consists of basal layer of endometrium that may be connected with mucosa
● Usually proliferative endometrium, although only 25% is proliferative during secretory phase
● Microscopic foci may be in vascular spaces resembling endometrial stromal sarcoma
● May be difficult to distinguish carcinoma invading myometrium from carcinoma involving adenomyosis

Micro images
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Various images

Differential diagnosis
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Endometrial stromal sarcoma: no glandular tissue, invades myometrium in tongues, no muscular hypertrophy, unusual to contain diffuse small regular glands (Am J Clin Pathol 1995;103:218)

End of Uterus > Non tumor > Adenomyosis


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