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case_images: Transrectal sonography reveals complex uterine lesion. (A) Transrectal sonography reveals a globular uterus with asymmetrical myometrial thickening and irregular junctional zones. A lobulated heterogeneous hyperechoic mass-like lesion, measuring approximately 75 x 57 x 55 mm, is observed at the anterior of the uterus. The lesion displays a few cystic changes and appears to be located at the junctional zone, invading the fundal deep myometrial region. (B) A close-up view of the hyperechoic mass-like lesion, showing its lobulated appearance and areas of cystic changes, further highlighting the complexity of the condition.
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case_images: Initial transabdominal sonography (TAS) revealed a typical presentation of adenomyosis in the uterus, indicated by the indirect findings of a globular shape, asymmetrical myometrial thickening, fan-shaped shadowing, and an irregular junctional zone in the anterior and posterior endometrium layers (Figure  1 ).
case_images: MRI unveils adhesions and uterine mass. MRI with sagittal section reveals an adhesion in the rectovesical space, along with adhesion of both ovaries to the uterus's body, suggesting a possible association with adenomyosis. A high-signal multicystic, well-defined mass is observed in the central part of the uterus on T2-weighted sagittal images, measuring approximately 76 x 53 x 59 mm. The origin of the mass cannot be distinguished as either myometrial or endometrial. It extends near the serosal surface in the left fundal part. The serosal surfaces of the uterus are intact, and there is no evidence supporting the cervical invasion.
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case_images: The mass's unclear boundaries, along with the patient's severe bleeding, led to further investigations (Figure  2 ).
case_images: Histological images of endometrial carcinoma arising from adenomyosis. (A) Sections reveal isolated nests of tumoral cells embedded beneath the myometrial layer (x4, H&E). (B) The neoplastic cells are arranged in back to back glands and complex papillary to villoglandular architectures (x10, H&E). (C) Stromal endometrial cell residues are seen focally at the periphery of some nests (black arrows) (x10, H&E).
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case_images: Other findings include chronic cervicitis in the cervix and unremarkable right ovary, fallopian tubes, and left ovary (Figure  3 ).