Adenomyosis is -

Ans. is 'd' i.e., Ectopic endometrial glands within the myometrium o Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium.o Most common site : Corpuso Rarely involves one of the walls of uterus or the cervixo Associated conditions:a) Leiomyomab) Pelvic endometriosisc) Endometrial hyperplasiad) Endometrial carcinomae) Endometrial polypsf) Salpingitis isthmica nodosao Microscopic pathophysiology:# There is no submucosal layer between the endometrium and myometrium; hence normally the endometrial glands in the basal layer penetrate into the myometrium to some extent. This poses a difficulty in diagnosis of adenomyosis, which is a pathological invasion of the endometrium.# Novak and Woodruff criteria: presence of heterotopic endometrium atleast 1 high power field (HPF) below the basal endometrium.# Bensen and Sneeden's criteria: Presence of ectopic endometrium (glands and stroma) at least two standard low power fields (= 4 mm) beneath the myometrial junction, and associated with adjacent myohyperplasia.o Grading of Adenomyosis:# Molitor's criteria: According to the depth of penetration:i) Grade I Inner 1/3 rd of myometriumii) Grade II Middle 1/3 rd of myometriumiii) Grade III: Outer 1 /3 rd of myometriumo Grading of Bird et al:# Mild: 1-3 glands/ LPF# Moderate: 4-9 glands / LPF# Severe: > 9 glands / LPFo Treatment# Medical management :Danazol, GnRH agonists# Surgical management: Endometrial resection, Uterine artery embolization, MRI - guided focused ultrasound surgery (MRIgFUS).