An unusual case of adenomyosis reported in Central India

Abstract

Adenomyosis is the presence of endometrial glands and stroma within the myometrium. A 40 years old nullipara presented with complaints of heavy bleeding during menses with passage of clots and white discharge with pain in abdomen more during menses for 3 years. On per abdomen examination a globular mass seen in lower abdomen below umbilical. It was about 20 weeks uterus size, firm, smooth with regular margins. Ultrasound was done which suggested bulky uterus of 9.6x11.9x8.5 cm, with heterogeneous myometrium globular fundus with increased vascularity and indistinct endomyometrial junction. Endometrial thickness of 4mm and normal ovaries. Mild hydronephrosis on both sides. MRI done suggested solid vascular mass lesion of 14.1x12x5.2cm with smooth margin in posterior wall of uterus extending to anterior wall of fundus with multiple cystic degeneration. Patient was not desirous of child in future and wanted permanent cure. So total abdominal hysterectomy with bilateral DJ stenting was done. Diffuse Adenomyosis was eventually confirmed in histopathology report.