Transvaginal ultrasound-guided biopsy of adenomyosis

Adenomyosis is a gynecologic disorder characterized by the presence of ectopic endometrial tissue within the uterine myometrium. It can involve most of the myometrium (diffuse adenomyosis), it may be present only in a circumscribed part of the myometrium (focal adenomyosis) or it may appear as a large cyst (adenomyotic cyst). The common sign of adenomyosis is uterine enlargement. Adenomyosis is asymptomatic in approximately one third of patients (1); alternatively, it may cause a wide range of aspecific symptoms including dysmenorrhea, deep dyspareunia and heavy menstrual bleeding (1,2). Adenomyosis may coexist with other gynecological conditions (such as uterine myomas and endometriosis) (3) making its diagnosis even more challenging. In the last 10 years, great attention has been given to the reproductive impact of adenomyosis. It has been demonstrated that women with adenomyosis have increased risk of developing late pregnancy complications caused by placental insufficiency such as small for gestational age newborns, premature rupture of membrane and preeclampsia (4,5)