case_images: PMC11810126_01
case_images: (A) Shows the T2 sagittal 3T Contrast enhanced Magnetic Resonance Imaging (CEMRI) pelvis showing cystic endometrial hyperplasia/endometrial neoplasm and myometrial thinning with loss of junctional zone (shown by yellow arrows); (B) Diffusion Weighted Imaging (DWI) and Apparent Diffusion Coefficient of 0.85 (shown by yellow arrows); (C) Shows transverse plane CEMRI pelvis showing myometrial thinning.
case_images: oncoscience-12-615-g001.jpg
case_images: PMC11810126_01_oncoscience-12-615-g001.jpg
case_images: F1
case_images: To further confirm the diagnosis, a Contrast-enhanced pelvic Magnetic Resonance Imaging (CEMRI) showed the presence of T2 hyperintense foci in the junctional zone and myometrium of fundus and upper uterine body anteriorly with evidence of effusion restriction with Apparent Diffusion Coefficient of 0.87 x 10-3 mm2/s on Diffusion-Weighted Imaging (DWI) (Figure 1).
case_images: (A) Cut-open hysterectomy specimen (uterus with cervix) showing fundal polyp (marked with yellow arrow) with overlying thin myometrium; Diffuse hyperplastic endometrium (marked with white arrow); (B) Formalin fixed hysterectomy specimen (weight 110 gms).
case_images: oncoscience-12-615-g002.jpg
case_images: PMC11810126_01_oncoscience-12-615-g002.jpg
case_images: F2
case_images: In view of the concerning findings on MRI and the characteristic clinical profile, a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed (Figure 2).
case_images: (A) Adenomyosis with glands (Thick arrow) in the myometrium (thin arrow). (5x, H and E stain); (B) Endometrial hyperplasia with surface lining on the right (Thick arrows), the gland to stroma ratio is increased and glands show proliferative features with round to tubular glands having stratification of cells (Thin arrow) (50X, H and E stain).
case_images: oncoscience-12-615-g003.jpg
case_images: PMC11810126_01_oncoscience-12-615-g003.jpg
case_images: F3
case_images: Contrary to the imaging findings, the histopathological examination revealed extensive glandular proliferation variant of adenomyosis co-existing with non-atypical endometrial hyperplasia (Figure 3).