UTERUS - Endometriosis

This is a hemisection of a uterus of normal size showing for the most part a smooth serosal surface. In the lower part of the body anteriorly there is a nodule of partly cystic tissue measuring approximately 2 x 2 cm. The presenting surface of this shows patchy areas of haemorrhage. The cervix is unremarkable. Histologically the area on the surface showing patchy haemorrhage is in fact a piece of bladder wall to which the uterus was adherent.
This woman presented with infertility and histological evidence of endometriosis in the connective tissue deep to the perineum. She did not respond to attempted hormonal suppression and finally the uterus and adnexae were removed together with the portion of involved bladder to which the uterus was firmly adherent.