Adenomyosis has long been referred to as the ‘elusive’ condition in gynaecology.1 Clinical diagnosis is complicated by symptoms shared with other gynaecological pathologies. Despite being a common part of preoperative workup, ultrasound and MRI lack both sensitivity and specificity.2

Histological assessment of the uterus, while viewed as gold standard, has an inter-pathologist variation as wide as 10–88%.3 The literature reports multiple reasons for this. Diagnosis predominantly relates to the distance of endometrial glands and stroma from the deepest point of the endomyometrial junction. The extent of invasion required for diagnosis, however, is still a matter of debate,4 with no consensus between pathology services. Furthermore, the spread of adenomyosis …