Photo clinic

Figure 1 a, b. Three-dimensional ultrasound showing the complete infiltration of the junctional zone. Adenomyosis is an idiopathic and benign disease in which ectopic endometrial glands embedded deeply in myometrial smooth muscle with the compensatory hypertrophy of the myometrium surrounding the ectopic endometrium (1, 2). There is a correlation between depth of the infiltration and initial too high stage of adenomyosis. Lesions may characterize as a diffuse or focal lesions. The highest prevalence occurs in parous women 30-50 years old and in half of the cases remains asymptomatic (2, 3). By now, there are no definitive detection methods for adenomyosis and the condition still remains a diagnostic challenge. Transvaginal ultrasound (TVS) is the primary imaging modality for preoperative diagnosis of diffuse adenomyosis. There is a broad spectrum of ultrasound features in adenomyosis. Typical adenomyosis on two-dimensional ultrasound (2D-TVS) is characterized by the presence of focal or diffuse myometrial heterogeneity (4, 5). Diffuse adenomyosis represents as asymmetric myometrial thickening and/or enlarged and globular uterus. Other findings in adenomyosis include echogenic nodules or linear striations extending from the endometrium into the myometrium results from presence of ectopic endometrial glands and stroma and also dilated cystic glands result in small myometrial cysts(1). In a recent review Reinhold and colleagues reported that TVS had a sensitivity of 80-86%, specificity of 50-96%,