Adenomyosis typically presents with which of the following findings?

• A. Benign invasive growth of the endometrium causing heavy, painful menses and a diffusely enlarged boggy uterus.
• B. Malignant invasion of the myometrium with a hard, nodular uterus.
• C. Endometrial hyperplasia with a small, non-tender uterus.
• D. Ectopic endometrial tissue limited to the cervix.

Answer: (A)

The key idea is that adenomyosis involves endometrial tissue growing within the muscular wall of the uterus, which leads to a uterus that is diffusely enlarged and has a boggy (soft) texture, along with heavy, painful menses. This combination—uniform uterine enlargement and a soft, tender uterus with dysmenorrhea and menorrhagia—fits adenomyosis.

Other patterns don’t match as well. A hard, nodular uterus with malignant invasion of the myometrium suggests fibroids or cancer rather than adenomyosis. A small or non-tender uterus with endometrial hyperplasia points to a different endometrial process without the diffuse uterine enlargement. Ectopic endometrial tissue outside the uterus (endometriosis) can cause pelvic pain but doesn’t typically produce a diffusely enlarged, boggy uterus. Cervical involvement is not the typical presentation of adenomyosis.