A retrospective analysis of spectrum of presentation of adenomyosis in tertiary centre

Abstract

Benign invasion of endometrial tissue into the myometrium of uterus is known as adenomyosis. It is found typically between the age of 35-50 years. Prevalence is 6-39%. Modern imaging techniques, both ultrasound (TAS, TVS) and MRI have made possible, for the first time, a non-invasive identification of adenomyosis. Aims & Objectives: To analyse the spectrum of presentation of adenomyosis and to determine the accuracy of clinical examination and imaging modalities in the diagnosis. Materials and Methods: It is a retrospective study done at hospitals attached to Bangalore Medical College & Research Institute during august 2016-august 2017. The HPE reports and case records of all the hysterectomy specimens were reviewed. Data regarding age, parity, symptoms, obstetric history, examination, co morbidities, investigation findings, associated pathology and treatment modality were noted. They were tabulated and analysed. Results: Out of the 50 patients, 56% were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 10% in post-menopausal women when compared to the age group 41-50yrs (56%). Multiparous women had 94% incidence of adenomyosis. 26% of women had prior uterine surgeries. 22% of cases had history of infertility in this study. 56% had menstrual disturbances. Dysmenorrhea & Dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology (38%). 34% had hyperplasia of endometrium whereas 66% had no pathology. Imaging picked up only 40% of cases contrary to 36% of clinical diagnosis and was raised to 66% with gross examination of specimen and 100% with HPE. Conclusion: Adenomyosis has a varied presentation. Ultrasound fails to diagnose all the cases. Clinical examination is a better modality. Associated pathology may mask the clinical features of adenomyosis, and diagnosis may be missed. Presently HPE is probably the gold standard for diagnosing adenomyosis.