A 45 years old patient presented with complaints of pain in abdomen and menorrhagia. Endometrial biopsy was normal and sonogram of uterus showed diffusely enlarged uterus with no adnexal mass. What is the diagnosis?

Ans: D: Adenomyosis(Ref: Shaw's 16Ie p413-413, 13/c p4T 3; Novak's 13Ie p184; Robbins 9Ie p1012)Clinical features like abdominal pain and menorrhagia with normal endometrial biopsy and on ultrasound diffuse, symmetrical enlargement of uterus, in a perimenopausal women without any focal lesion is highly suggestive of Adenomyosis.Clinical symptoms include menometrorrhagia (irregular and heavy menses), colicky dysmenorrhea, dyspareunia, and pelvic pain, paicularly during the premenstrual period.Coexist with endometriosis.Often asymptomatic.Uterus is diffusely enlarged, although usually less than 14 cm in size, and is often soft and tender, paicularly at the time of menses.