Adenomyosis

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Adenomyosis is the non-neoplastic (benign) invasion of endometrium into the myometrium of the reproductive female. It is a relatively common disorder (15-30% of resected uteri), but causes symptoms in only a small percentage of patients, usually late in the reproductive years. Abnormal genital tract bleeding such as menorrhagia and metrorrhagia are the most common complaints, followed by nonspecific pelvic pain and bladder and rectal pressure. On examination, the patient may have a large uterus.

The cause of disease is unknown (i.e., the disease is idiopathic), though it is uncommon in nulligravids, which leads to the belief that it may be parity-related.

Ultimately, diagnosis can only be definitively made with imaging, such as with magnetic resonance imaging (MRI), though it may be an incidental finding after a hysterectomy.

Upon gross pathological examination, the uterus is enlarged by a diffuse process, and the myometrium is thick, trabecular, and may be cystic. Microscopically, endometrial tissue can be found deep in the myometrium, and is usually usually more than 1/4 of the wall's thickness. Also, there is smooth muscle hypertrophy.

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