The preoperative diagnosis of adenomyosis

The charts of 46 patients between the ages 30-50 years having a hysterectomy for a fibroid uterus were reviewed. The diagnosis of adenomyosis was correctly made preoperatively in four patients. The diagnosis was not made preoperatively in 13 patients in whom adenomyosis was demonstrated on pathologic examination of the surgical specimen. The preoperative diagnosis of adenomyosis is difficult. Pain and abnormal bleeding are frequent symptoms. There is uterine enlargement which is demonstrated on pelvic ultrasound. Occasional characteristic findings may be noted on hysterogram. Adenomyosis and fibroids often coexist. The treatment of choice is hysterectomy.