Adenomyosis in the Uterine Wall

Description

Cut in section, the uterus is opened to reveal the endometrium lining the uterine cavity and the surrounding myometrium thickened by adenomyosis, with scattered ectopic endometrial glands and stroma embedded deep to the basal layer. Dark punctate foci track within the myometrium, often concentrated near the endometrial myometrial junction (junctional zone), giving a mottled appearance rather than a discrete, capsulated mass. Laterally, the uterine cornua continue into the fallopian tubes, and the ovaries sit posterolateral to the uterine fundus at the ends of the tubo-ovarian complexes. Adenomyosis matters because it blurs the boundary between endometrium and myometrium, the anatomic change that underlies a globally enlarged, tender uterus and the classic symptoms of heavy menstrual bleeding and progressive dysmenorrhea. Differentiation from leiomyoma and from peritoneal endometriosis is a day-to-day clinical problem: adenomyosis tends to produce diffuse myometrial thickening and small hemorrhagic foci, while fibroids displace the endometrial cavity as well-circumscribed nodules. MRI and high-resolution transvaginal ultrasound both hinge on this anatomy, with junctional zone thickening and myometrial cysts guiding diagnosis and informing choices between medical therapy (progestins, LNG-IUS, GnRH analogs), uterine-sparing procedures, and hysterectomy. Use this artwork in OB-GYN and reproductive endocrinology teaching modules to contrast normal uterine wall layers with adenomyotic infiltration, and in radiology or pathology publications when correlating gross section anatomy with imaging criteria and symptom patterns. It also fits patient-facing counseling materials that explain why pain and bleeding can persist despite a normal-appearing endometrial cavity. Anatomical accuracy verified by SciePro's Medical Advisory Board.