Pathophysiology Cross section through the wall of a hysterectomy specimen of a 30-year-old woman who reported chronic pelvic pain and abnormal uterine bleeding. The endometrial surface is at the top of the image, and the serosa is at the bottom.Misplaced endometrial tissue proliferation in the myometrium causes symptoms through different mechanisms. Uterine menstrual contractions are caused by prostaglandin, which is produced by normal endometrial tissue. Dysmenorrhea is the main characteristic for this disease which are the result for high prostaglandin levels. Endometrial proliferation is also led by estrogen; some treatments try to reduce its levels in order to decrease symptoms.<unk>  patients present with heavy menstrual bleeding due to the increase of endometrial tissue, greater degree of vascularization, atypical uterine contractions and increased levels of prostaglandins, estrogen and eicosanoids. Histopathology The diagnosis of<unk>  is through a pathologist microscopically examining small tissue samples of the uterus. These tissue samples can come from a uterine biopsy or directly following a hysterectomy. Uterine biopsies can be obtained by either a laparoscopic procedure through the abdomen or hysteroscopy through the vagina and cervix. The diagnosis is established when the pathologist finds invading clusters of endometrial tissue within the myometrium. Several diagnostic criterion can be used, but typically they require either the endometrial tissue to have invaded greater than 2% of the myometrium, or a minimum invasion depth between 2.5 and 8mm.Histopathological image of uterine<unk>  observed in hysterectomy specimen. Hematoxylin & eosin stain. Gross Findings: #Enlarged uterus #Thickened uterine wall with trabeculated appearance #Hemorrhagic pinpoint or cystic spaces throughout wall Microscopic Findings: #Endometrial glands and stroma haphazardly distributed throughout myometrium #Concentric myometrial hyperplasia frequent around adenomyotic foci #Variants: Gland-poor, stroma-poor, intravascular Differential Diagnosis: #Adenomyoma #Myo-invasive endometrial endometrioid carcinoma (vs. stroma-poor<unk>  #Low-grade endometrial stromal sarcoma (vs. gland-poor and intravascular<unk>
Adenomyosis
Endometrial polyp
Leiomyoma
Endometrial hyperplasia
Cervical pregnancy
Endometriosis
Uterine fibroid
Endometrial intraepithelial neoplasia