Hysteroscopic Findings in an Unusual Case of Adenomyosis

Adenomyosis is the presence of ectopic endometrial glands and stroma in the myometrium. It traditionally presents with pelvic pain, menorrhagia and dysmenorrhea in the fourth or fifth decade of life. Here, we present a case of adenomyosis presenting with severe menorrhagia at the age of 23 years. Traditionally, adenomyosis is diagnosed in histopathologically, in hysterectomy specimens or myometrial biopsies. Noninvasive modalities, such as transvaginal ultrasound and magnetic resonance imaging aid in diagnosis in the office before treatment is undertaken. Office hysteroscopy is an established tool in the diagnosis of abnormal uterine bleeding and infertility.While hysteroscopy does not have pathognomonic features of adenomyosis, certain patterns have been described in association with adenomyosis, including endometrial defects, abnormal vascularization and cystic hemorrhagic lesions. In this case of adenomyosis, typical appearance of circumscribed endometrial defects on hysteroscopy was seen. This appearance has been described in literature but is the first report from India. Hysteroscopy has the potential to be an important additional procedure for the evaluation of uterine pathology, even in the case of adenomyosis, because it offers the main advantage of direct visualization of the uterine cavity and the possibility of obtaining histological specimens under visual control. With shifting focus toward conservative and fertility preserving management of adenomyosis, office hysteroscopy is likely to emerge as an important tool in the diagnostic armamentarium for adenomyosis.