Adenomyosis

Definition

What adenomyosis is

• Definition: Adenomyosis is defined as glands/stroma in myometrium with muscle hyperplasia.
• Symptoms: Common symptoms are hypermenorrhoea, dysmenorrhoea, and pressure.
• Association: Adenomyosis often with endometriosis.
• Epidemiology: It predominantly affects perimenopausal women, often after procedures.

Clinical features

More facts from the study questions

• An adenomyoma is characteristically ill-defined, whereas a fibroid has a clear border.
• The MUSA (Morphological Uterus Sonographic Assessment) criteria include myometrial cysts.
• An irregular, thickened or interrupted junctional zone is also a characteristic sonographic finding.
• The pathological definition of adenomyosis is the presence of endometrial-like glands and stroma within the myometrium.
• Adenomyosis can occur in isolation, but it is also frequently associated with endometriosis.

Diagnosis

MUSA

• Acronym: MUSA stands for Morphological Uterus Sonographic Assessment.
• Uterine shape: A MUSA criterion is globular uterus with asymmetric walls.
• Cysts: Another sonographic criterion is myometrial cysts.
• Echogenicity: The MUSA criteria also include hyperechoic islands and fan-shaped shadowing.
• Junctional zone: A typical finding is an irregular, thickened junctional zone.
• Vascularisation: The vessel architecture shows translesional, penetrating vessels.

Typical imaging findings

• Ultrasound: The uterus is globularly enlarged with asymmetric anterior and posterior wall thickness. Fine, fan-shaped shadow stripes run vertically through the myometrium — the typical venetian-blind pattern; the endometrium itself is normal.
• Ultrasound: The myometrium is asymmetrically thickened and studded with small anechoic spaces. The junction between endometrium and myometrium is ill-defined and wavy, without any encapsulated mass.

Keep learning in the app

Further reading (selection)

1. StatPearls: Adenomyosis (NCBI Bookshelf)
2. DocCheck Flexikon, Adenomyosis uteri

Cross-references