Adenomyosis

Adenomyosis describes invasion of the muscle of the uterus (myometrium) by the lining of the uterus (Endometrium).  It was first described by Rokitansky in 1860 but there was an important account by TS Cullen in 1908.  Cullen described four different patterns of the condition.  It is important to distinguish the different patterns.

The two important patterns are diffuse symmetrical adenomyosis (DSA, Fig.1) where the lining of the uterus replaces the muscle almost entirely. all the examples on this page refers to a series of 34 cases of DSA studied in China – where it is common in some units. The second pattern is focal, asymmetrical adenomyosis (FAA).

Fig 1 Diffuse symmetrical adenomyosis (DSA) in uteri weighing 260g and 1140g respectively.  Uncommon in UK but they are painless and present with pressure on the bladder or rectum.  There are no nerves in these uteri of Fallopian tubes (Fig. 2) and the uterosacral ligaments are completely destroyed (Fig. 3). Patients have often had a prior abortion after 16 weeks gestation.

Fig. 2 a-d isthmus of Fallopian tube; 2a is normal; 2b-d shows complete loss of villi and nerves in women with DSA

Fig 2e-h ampulla of Fallopian tube; 2e is normal; 2f-h shows complete loss of villi and nerves in women with DSA

Fig 3 Uterosacral ligaments in DSA. 3a and 3e are normal. The rest show different degrees of injuries to the uterosacral ligaments with a congenital abnormality in 3c and complete loss of ligaments in 3h following multiple abortions.