Adenomyosis or endometrial carcinoma? Radiological pitfalls in postmenopausal diagnosis: a case report

Abstract

Abstract Background Adenomyosis and endometrial carcinoma present distinct pathological conditions that pose considerable diagnostic hurdles, especially in postmenopausal women, as they share common clinical manifestations. Furthermore, postmenopausal adenomyosis may exhibit radiological features resembling those of endometrial carcinoma, potentially leading to misdiagnosis and inappropriate management. Case presentation A 64-year-old para four and live four (P4L4) postmenopausal woman, who had been postmenopausal for 15 years, sought evaluation at the Gynecological Outpatient Department due to heavy postmenopausal bleeding lasting 30–45 days. Ultrasonography and MRI findings indicated a loss of the endo-myometrial junctional zone, delayed enhancement of the lesion, and suspected myometrial invasion, suggestive of endometrial malignancy, alongside a polypoidal lesion. Given the strong suspicion of endometrial carcinoma, the patient underwent hysteroscopy-guided endometrial biopsy. However, histopathological analysis revealed disordered proliferative endometrium with no evidence of malignancy. Considering the patient's age, symptoms, and MRI findings, exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy was planned. Subsequent histopathological examination confirmed adenomyosis of the uterus, with the fallopian tubes and ovaries found to be healthy. Conclusion The present case report underscores the radiological challenges encountered in distinguishing adenomyosis from endometrial carcinoma in postmenopausal women, emphasizing the importance of a multidisciplinary approach to enhance diagnostic accuracy and improve patient outcomes in this population.

Keywords

• Adenomyosis
• Endometrial carcinoma
• Magnetic resonance imaging
• Postmenopausal
• Uterus