Background: Adenomyosis alone usually does not cause significant uterine enlargement.
Case: A 49-year-old woman underwent vaginal hysterectomy and pelvic reconstructive surgery for pelvic organ prolapse. Incidentally, she was found to have adenomyosis with a 475-gram uterus without any other uterine histopathologic finding. To our knowledge, this is the largest uterus with adenomyosis alone ever reported.
Conclusion: Extreme enlargement of the uterus is possible due to adenomyosis alone.
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