Sclerotic adenomyosis: a case report

This retrospective case report analyzed 450 surgical cases initially diagnosed as adenomyosis and uterine fibroids, finding the sclerotic type of adenomyosis in 3 patients (0.67%), and used these cases to describe clinical, echographic, and histological features. Across the three patients (mean age 38 ± 1.3 years), all had heavy menstrual bleeding, dysmenorrhea, and infertility; primary infertility was present in one and secondary infertility in two, and imaging showed posterior uterine wall lesions with irregular contours and no Doppler blood flow, with macroscopic gray myometrial thickening lacking a clear capsule. Histology demonstrated two patterns of sclerotic adenomyosis depending on lesion location—between smooth muscle bundles in two cases, and between smooth muscle bundles with involvement of leiomyoma nodules in one case. This paper is centrally about endometriosis–adenomyosis overlap mechanisms, because the reported sclerotic adenomyosis lesions included foci of endometriosis between smooth muscle fibers, directly relating it to endometriosis/adenomyosis; it is also explicitly about adenomyosis, specifically the sclerotic form.

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