A 38-year-old woman presents with heavy menstrual bleeding and dysmenorrhea. Ultrasound shows a globular uterus measuring 12×11×10 cm with heterogeneous myometrium and asymmetric posterior wall thickening of 22 mm. The endometrial-myometrial junctional zone is indistinct. There are no discrete fibroids. What is the MOST likely diagnosis?
- A Subserosal fibroid uterus
- B Adenomyosis ✓
- C Endometrial carcinoma
- D Myometrial leiomyosarcoma
Correct answer: B. Adenomyosis
Explanation
The features described are classic for adenomyosis: globular uterus, heterogeneous myometrium, asymmetric wall thickening, and loss of the endometrial-myometrial junctional zone on ultrasound. On MRI, the junctional zone thickness >12 mm is diagnostic. No discrete fibroid is present. Adenomyosis represents ectopic endometrial glands within the myometrium causing secondary dysmenorrhea and menorrhagia. The gold standard diagnosis is histology after hysterectomy, but MRI is the best preoperative imaging tool.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.