Accurate Representation of Adenomyosis

Description

Coronal cut-section of the uterus exposes the endometrial cavity and adjacent myometrium, with the tubal ostia visible at the superolateral angles of the fundus. Scattered, punctate foci within the thickened myometrial wall represent ectopic endometrial glands and stroma embedded below the endometrial basalis, producing a mottled appearance rather than a discrete, encapsulated mass. The endometrium lines the central cavity, while the expanded myometrium surrounds it circumferentially, increasing uterine wall thickness and overall uterine bulk. Serosal contour remains smooth. No capsule. Adenomyosis matters because its anatomy explains the symptoms: ectopic endometrium within myometrium undergoes cyclic bleeding, provoking hypertrophy and hyperplasia of surrounding smooth muscle, which correlates with heavy menstrual bleeding, dysmenorrhea, and a diffusely enlarged, tender, “boggy” uterus on bimanual exam. Differentiating this diffuse infiltrative pattern from uterine leiomyomas is clinically relevant when selecting medical therapy (levonorgestrel IUS, GnRH analogs) versus uterine-sparing procedures, and it mirrors what radiologists describe on MRI as thickening and irregularity of the junctional zone with small myometrial cysts. Surgical planning also depends on the distribution, since adenomyotic tissue lacks a clean plane for enucleation and can increase bleeding risk during myomectomy or hysterectomy. Use this illustration in gynecology lectures covering abnormal uterine bleeding, dysmenorrhea, and endometriosis spectrum disorders, or in pathology and radiology teaching sets that compare adenomyosis to leiomyoma and endometrial hyperplasia using gross-correlative anatomy. It also fits patient-facing education materials that need a clear internal view of the womb and endometrium while staying anatomically faithful. Anatomical accuracy verified by SciePro's Medical Advisory Board.