{"paper_id":"3ccf0ca1-eb47-46ed-b77b-86f8fc0b70f9","body_text":"Alves et al. Clin Med Img Lib 2023, 9:226\nVolume 9 | Issue 2\nOpen Access\nISSN: 2474-3682\nClinical Medical Image Library\n• Page 1 of 3 •\nAlves et al. Clin Med Img Lib 2023, 9:226\nDOI: 10.23937/2474-3682/1510226\nCitation: Alves F, Gomes Z, Fan Y, Moreira A, Moutinho O (2023) Uterine Adenomyosis: An Uncommonly \nOversized Uterus in a 30-Year-Old Patient. Clin Med Img Lib 9:226. doi.org/10.23937/2474-\n3682/1510226\nCopyright: © 2023 Alves F, et al. This is an open-access content distributed under the terms of the \nCreative Commons Attribution License, which permits unrestricted use, distribution, and reproduction \nin any medium, provided the original author and source are credited.\nAccepted: December 15, 2023; Published: December 17, 2023\nUterine Adenomyosis: An Uncommonly Oversized Uterus \nin a 30-Year-Old Patient\nFernanda Alves*, Zélia Gomes, Yida Fan, Ana Moreira and Osvaldo Moutinho\n*Corresponding author: Fernanda Cristina Ribeiro Alves, Obstetrics and Gynecology Department, Centro Hospitalar de \nTrás-os-Montes e Alto Douro, Vila Real, Portugal, Tel: 91-697-7951\nObstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal\nIMAGe - New TechNIque\nCheck for\nupdates\nIntroduction\nUterine adenomyosis is a disorder in which \nendometrial glands and stroma are present within \nthe myometrium, resulting in hypertrophy of the \nsurrounding myometrium [1,2]. Its exact epidemiology \nis uncertain as data regarding this condition has often \nrelied on the assessment of the uterus following \nhysterectomy. However, studies have reported that \nit seems to be present in a wide range of individuals \nundergoing hysterectomy (9-62%) [3].\nIt was previously described as a disease that \ndeveloped in women in their 40-50s; nevertheless, \nstudies using imaging diagnosis of adenomyosis suggest \nthat it can frequently be detected at younger ages (with \na reported prevalence of 20-35%) [4-6].\nPatients will often present with uterine enlargement, \npainful menses, abnormal uterine bleeding (AUB) and \nchronic pelvic pain.\nAdenomyosis often coexists with other uterine \ndisorders, such as uterine leiomyoma and/or \nendometriosis, which can obscure its diagnosis.\nCase Description\nWe present a case of a 30-year-old patient who \nentered the emergency department complaining of an \nexuberant edema in the left lower limb with one week \nof evolution and no other associated symptoms.\nShe was healthy with no usual medication. The \npatient haven´t undergone any surgery and had no \nknown drug allergies. Menarche at the age of 11; she \ndenied any previous sexual intercourse. She reported \nregular and prolonged menses.\nThe initial clinical suspicion was that the signs \nand symptoms corresponded to a case of deep vein \nthrombosis of the lower limb. However, on physical \nexamination, the patient was pale and on abdominal \npalpation, it was possible to denote a huge mass that \noccupied the whole abdomen and extended to the \nxiphoid process.\nOn the laboratory evaluation, she had serious \nanemia (Hemoglobin level of 4.6 g/dL), with no other \nmajor changes. To better characterize this mass, an \nabdominopelvic computed tomography (CT) was \nrequested, which showed the existence of a large \nmass (with 17*28 cm of maximum diameters) with \nan apparent uterine origin - admitting possible \nleiomyomatous/sarcomatous lesion (Figure 1 and \nFigure 2). Lactic dehydrogenase and other tumor \nmarkers were all negative.\nThe patient was transfused with a total of 5 units of \nred blood cells in preparation for elective surgery. She was \nposteriorly submitted to an exploratory laparotomy.\nFigure 3, Figure 4 and Figure 5 show the aspect of the \npatient´s uterus, which weighted a total of 2900 grams. \nGiven the size of the uterus, we decided to perform a \ntotal hysterectomy with bilateral salpingectomy. The \npostoperative period was uneventful.\nThe histological result of the surgical specimen \nconfirmed the presence of adenomyosis and uterine \nleiomyomas.\n\nISSN: 2474-3682\nDOI: 10.23937/2474-3682/1510226\nAlves et al. Clin Med Img Lib 2023, 9:226\n• Page 2 of 3 •\n1\n2\nFigure 1 and Figure 2:  CT scan showing the enlarged uterus (with measures of its diameters).\n\nISSN: 2474-3682\nDOI: 10.23937/2474-3682/1510226\nAlves et al. Clin Med Img Lib 2023, 9:226\n• Page 3 of 3 •\n \n \n \n \n \n \n \n \n \n \n \n \n \n \nFigure 3, Figure 4 and Figure 5: Corresponding images of intraoperative findings.\n2. Zhai J, Vannuccini S, Petraglia F, Giudice LC (2020) \nAdenomyosis: Mechanisms and pathogenesis. Semin \nReprod Med 38: 129-143.\n3. Upson K, Missmer SA (2020) Epidemiology of Adenomyosis. \nSemin Reprod Med 38: 89-107.\n4. Pinzauti S, Lazzeri L, Tosti C, Centini G, Orlandini C, et \nal. (2015) Transvaginal sonographic features of diffuse \nadenomyosis in 18-30-year-old nulligravid women without \nendometriosis: Association with symptoms. Ultrasound \nObstet Gynecol 46: 730-736.\n5. Naftalin J, Hoo W, Nunes N, Holland T, Mavrelos D, et \nal. (2016) Association between ultrasound features of \nadenomyosis and severity of menstrual pain. Ultrasound \nObstet Gynecol 47: 779-783.\n6. Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, et \nal. (2012) How common is adenomyosis? A prospective \nstudy of prevalence using transvaginal ultrasound in a \ngynaecology clinic. Hum Reprod 27: 3432-3439.\nWith this clinical case portrait, the authors propose \nto highlight the importance of approaching the patient \nas a whole; furthermore, it is also intended to warn that \nadenomyosis can affect young patients and have an \nimportant impact, which can result in significant uterus´ \ngrowth.\nAcknowledgements\nThe authors declare that they have no conflict of \ninterest regarding the publication of this case report.\nNo funding from an external source supported the \npublication of this case report.\nAll authors equally contributed to the execution of \nthis paper.\nReferences\n1. Ferenczy A (1998) Pathophysiology of adenomyosis. Hum \nReprod Update 4: 312.","source_license":"CC0","license_restricted":false}