A 38-year-old woman complains to her physician of chronic pelvic pain that is much worse during her menstrual periods. Pelvic examination demonstrates an enlarged uterus with multiple palpable masses. Ultrasound shows that a large number of ball-like masses up to 6 cm diameter are present in the uterus. Which of the following is the most likely cause of the ball-like masses in her uterus?
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