Multimodal imaging in the diagnosis of uterine polypoid adenomyoma: a case report

Uterine polypoid adenomyoma (UPA) is a rare focal form of adenomyosis that can present as an intracavitary lesion and pose a significant diagnostic challenge, often mimicking more common or concerning entities, such as endometrial polyps or uterine adenosarcoma. We describe the case of a 53-year-old woman who presented with profound anemia (hemoglobin 3.9 g/dL) secondary to acute on chronic heavy vaginal bleeding. Multimodal imaging, including ultrasound and MRI, prompted the initial diagnosis of UPA, later supported by surgical pathology. Ultrasound demonstrated diffusely heterogeneous myometrial echotexture and multifocal "venetian blind" artifact consistent with adenomyosis. MRI revealed an ovoid lesion within the endometrial cavity containing numerous T2 hyperintense cystic foci and imaging characteristics similar to the junctional zone, consistent with a submucosal UPA. Management included blood transfusions, hormone therapy, and ultimately hysterectomy. This case serves to underscore the importance of a combined approach, including both multimodal imaging and histopathology, in guiding the accurate diagnosis and optimal management of UPA. It is also intended to increase awareness of this rare lesion and encourage its consideration in the differential diagnosis of intracavitary uterine masses, as it may have implications for treatment planning.