Recognizing the Spectrum of Sonographic Presentations of Adenomyosis in the Peri-Menopausal Women Underwent Hysterectomy

Abstract

Background: Adenomyosis is a non-malignant infiltration of endometrial tissue into the myometrium, resulting in a globular uterus.  It typically diminishes after menopause. Thus, it is rarely reported in post-menopausal women. Clinically, it is difficult to be differentiated from other gynecological conditions (e.g., Fibroid). Pelvic ultrasound can be aid the clinician to reach diagnosis. However, there is no universally accepted classification system specific for diagnosis. The current work aimed to explore the spectrum of sonographic findings detected in peri-menopausal women that treated by hysterectomy.

Materials and Methods: This retrospective study comprised 42 female patients underwent hysterectomy as definitive treatment for their gynecological illness. The post-operative specimens proved the diagnosis of adenomyosis. The study conducted at Al-Azhar university hospital New Damietta, Egypt at the period from January 2019 to December 2020.  Revision of medical records for history (e.g., symptoms, contraceptive use, operations and general medical disorders). It also included, the recorded abdominal and pelvic examinations and the findings of sonographic evaluations.

Results: The patient’s age ranged between 45 and 70 years. Of who 57.14% were pre-menopausal while 42.86% were postmenopausal. The clinical presentation included chronic pelvic pain, menstrual irregularities, inter-menstrual bleeding, post-menopausal bleeding, dysmenorrhea, dyspareunia and history of infertility. History of Hormonal treatment was positive in 21.43%. The ultrasound examinations revealed bulky globular uterus (50%), diffusely inhomogeneous myometrium (64.29%), scattered hyperechoic foci/striations within myometrium (33.33%), scattered myometrial minute cysts and/or hypoechoic striations (45%), abnormal junctional zone (40.48%), focal adenomyoma (35.71%) and asymmetry in uterine wall thickness (14.19 %). Associated findings including, non-neoplastic thickened endometrium (14.29%), fibroids (19.05%) and non-neoplastic adnexal cysts (26.19%).

Conclusion: The adenomyosis is non-expected at advanced age. However, if present, it can be identified accurately by a competent ultrasound examination.