51-Year-Old Female with Adenomyosis

Clinical History

51-year-old female with dysmenorrhea and pelvic pain.

Image 1a above shows normal junctional zone.  Images 2a, 2b, and 2c show a retroflexed uterus with enlarged junctional zone compatible with Diffuse Adenomyosis. Images 3a and 3b show an enlarged junctional zone in the posterior and left lateral uterus compatible with Focal Adenomyosis.

Diagnosis

Adenomyosis of the Uterus

Adenomyosis is a condition in which heterotopic endometrial glands are found in the myometrium. This condition is more commonly associated with multiparity, trauma and surgery to the uterus. Adenomyosis is diagnosed utilizing MRI with an accuracy of 85%. MRI is used because the junctional zone in the uterus is only seen on MRI and it cannot be visualized on CT and ultrasound. The junctional zone is the low signal intensity zone seen on the T2-weighted images on MRI and appears dark, or low-signal, and contains myocytes with lower water content. The junctional zone is the innermost layer of the myometrium.

The normal junctional zone measures less than 12mm.If the junctional zone measures greater than 12mm it represents Diffuse Adenomyosis.  Adenomyosis can also be Focal. The differential diagnosis for focal adenomyosis is a leiomyoma.

Management

Patient underwent hysterectomy, which is the treatment of choice.

References

Novellas S, Chassang M, Delotte J, Toullalan O, Chevallier A, Bouaziz J, Chevallier P. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol. 2011;196(5):1206–13.