A 45-year-old woman presents with menorrhagia and secondary dysmenorrhoea for 2 years. Examination reveals a uniformly enlarged, globular, tender uterus of 10-week size. Transvaginal ultrasound shows heterogeneous myometrium with posterior wall predominance, no discrete fibroid. Serum CA-125 is mildly elevated (55 U/mL). What is the MOST likely diagnosis?
- A Uterine fibroid (leiomyoma)
- B Adenomyosis ✓
- C Endometrial carcinoma
- D Endometriosis with uterine involvement
Correct answer: B. Adenomyosis
Explanation
Adenomyosis classically presents in multiparous women aged 40–50 years with progressive secondary dysmenorrhoea, menorrhagia, and a symmetrically enlarged, globular, tender uterus ('boggy'). Ultrasound shows heterogeneous myometrium, asymmetric wall thickening, myometrial cysts, and fan-shaped posterior shadowing. CA-125 can be mildly elevated (usually <200 U/mL). Fibroids produce focal nodules with distinct margins. The absence of a discrete mass and the heterogeneous echotexture favour adenomyosis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.