Differential Diagnosis

• Single most likely diagnosis
  • Adenomyosis: The presence of myometrial cysts and a heterogenous appearance of the endometrium with small cysts are suggestive of adenomyosis, which is a condition where tissue similar to the lining inside the uterus is found outside its normal location in the uterine walls.
• Other Likely diagnoses
  • Cystic hyperplasia: The description of a heterogenous appearance of the endometrium with small cysts supports this diagnosis, as cystic hyperplasia is characterized by an overgrowth of the endometrial lining, leading to the formation of cysts.
  • Uterine fibroids (leiomyomas): The mention of a 1.7 cm anterior intramural fibroid directly supports this diagnosis, as fibroids are benign tumors that can grow within the uterine walls.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Endometrial carcinoma: Although neoplasia is not excluded, the presence of a heterogenous endometrium and small cysts could potentially be indicative of a more serious condition like endometrial cancer, making it crucial not to miss this diagnosis.
  • Sarcoma: Although rare, sarcomas (including leiomyosarcoma, a malignant form of fibroid) could present similarly to benign fibroids or other conditions mentioned, and missing this diagnosis could have severe consequences.
• Rare diagnoses
  • Adenocarcinoma arising in adenomyosis: This is a rare condition where cancer develops within adenomyotic tissue, and while unlikely, it's a consideration given the adenomyosis features and the exclusion of neoplasia.
  • Metastatic disease to the uterus: Although rare, cancer from other parts of the body can metastasize to the uterus, presenting with a variety of imaging findings that could overlap with those described.