Focal adenomyosis

Case contributed by Ian Bickle


Irregular periods. Nulliparous. Ultrasound performed by clinician suggests a uterine fibroid.

Patient Data

Age: 45 years
Gender: Female

Prior non-departmental ultrasound.

Ill-defined 6.3 centimeter ovoid low T2 signal abnormality in the posterior body of the uterus. This is centered on the junctional zone, but predominantly involving the myometrium.

This is indenting and displacing the endometrial cavity anteriorly. Multiple tiny focus of high T2 change within this mass like abnormality indicative of cystic change.

6 millimeter high T1 signal element within, suggestive of hemorrhage.

Normal cervix.

No pelvic lymphadenopathy.

Case Discussion

Adenomyosis of the uterus is a relatively common abnormality of the uterus. It is thought by many to be on the spectrum of endometriosis, with ectopic endometrial tissue in the myometrium. It can be divided into diffuse and focal types, the former by far being the more common.  Focal adenomyosis is also known as an adenomyoma.

Adenomyosis usually presents with menorrhagia and dysmenorrhea.

Initially, ultrasound and then MRI are imaging modalities of choice - the latter being highly diagnostic.

Focal adenomyosis, as in this case, is usually evident as a localized, low-signal-intensity region in the myometrium on both T2-weighted and contrast-enhanced T1-weighted sequences. This region is often continuous with the junctional zone, this being the usual site for the disease.

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