| EPIDEMIOLOGY |
CHARACTERIZATION |
| INCIDENCE/PREVALENCE |
|
Prevalence and risk factors of adenomyosis at hysterectomy.
Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB.
Department of Obstetrics and Gynaecology and 2Department of Pathology, Gentofte University Hospital, Niels Andersens Vej 65, 900 Hellerup, Denmark. |
Hum Reprod 2001 Nov;16(11):2418-21 Abstract quote
BACKGROUND: The present study was performed to evaluate the prevalence and possible associated risk factors for adenomyosis.
METHODS: Medical records were retrieved and histo-pathological material re-examined for 549 consecutive women undergoing hysterectomy in a two-year period from 1990-1991.
RESULTS: The prevalence of adenomyosis in the study varied from 10.0-18.2%, depending on different diagnostic criteria. The presence of endometrial hyperplasia at the time of hysterectomy was the only variable significantly associated with adenomyosis (OR = 3.0; 95% CI: 1.2-8.3). No statistically significant association was found between adenomyosis and previous caesarean section, endometrial curettage or evacuation of the uterus. Furthermore, we did not see any significant association between adenomyosis and pain-related symptoms, indication for hysterectomy, age, parity or number of myometrial samples.
CONCLUSIONS: Our study stresses the need for precise diagnostic criteria for adenomyosis, and furthermore indicates that endometrial hyperplasia and adenomyosis may have a common aetiology. |
Adenomyosis at hysterectomy: prevalence and relationship to operative findings and reproductive and menstrual factors.
Vavilis D, Agorastos T, Tzafetas J, Loufopoulos A, Vakiani M, Constantinidis T, Patsiaoura K, Bontis J.
2nd Department of Obstetrics and Gynaecology, Aristotelian University of Thessaloniki, Greece. |
Clin Exp Obstet Gynecol 1997;24(1):36-8 Abstract quote
In order to estimate the frequency and risk factors for adenomyosis, the clinical records of 594 women undergoing hysterectomy were retrieved.
Data were collected on indications for the intervention, age at surgery, age at menarche, parity, abortions, mode of delivery, abnormal uterine bleeding, dysmenorrhea, and menopausal status at surgery. Adenomyosis was found in 116 of the 594 patients (19.5%). A pathologic condition was present in 63 patients with fibroids (20.5%), 11 with genital prolapse (25.6%), 11 with benign ovarian tumors (17.8%), six with endometrial hyperplasia (13.6%), two with cervical cancer (18.2%), ten with endometrial cancer (16.1%), and 13 with ovarian cancer (21.3%). No relationship was found between adenomyosis and endometriosis. On the contrary, a strong relationship was found between adenomyosis and parity, cesarean section, induced abortions, dysmenorrhea, abnormal uterine bleeding, and late age at menarche.
These results show that adenomyosis is a common pathologic finding, significantly related to reproductive and menstrual characteristics of the patients. |
| PATHOGENESIS |
CHARACTERIZATION |
|
Immunohistochemical assessment of superoxide dismutase expression
in the endometrium in endometriosis and adenomyosis.
Ota H, Igarashi S, Hatazawa J, Tanaka T.
Department of Obstetrics and Gynecology, Akita University School
of Medicine, Akita-city, Japan.
|
Fertil Steril 1999 Jul;72(1):129-34 Abstract quote
OBJECTIVE: To determine the expression of superoxide dismutase (SOD)
in the endometrium during the menstrual cycle in endometriosis and
adenomyosis.
DESIGN: Immunohistochemical identification of SOD in endometrial
tissues using the monoclonal antibody.
SETTING: Department of obstetrics and gynecology in a university
hospital.
PATIENT(S): The subjects were divided into three groups: 36 patients
with endometriosis, 38 patients with histologically proven adenomyosis,
and 47 fertile control subjects.
INTERVENTION(S): Endometrium was biopsied throughout the menstrual
cycle. MAIN
OUTCOME MEASURE(S): Semiquantitative immunostaining (evaluation nomogram)
score for endometrial cells.
RESULT(S): The analyses revealed phase-dependent changes in the expression
of SODs in the glandular and surface epithelia during the menstrual
cycle in fertile controls. Specifically, the expression of copper,
zinc SOD was weakest in the early and midproliferative phases, then
gradually increased, and was most marked in the early and midsecretory
phases. The expression of manganese SOD reached a peak in the late
secretory phase. The expression of both SODs in endometriosis and
adenomyosis was persistently higher than the control levels throughout
the menstrual cycle.
CONCLUSION(S): The exaggerated expression of both SODs in the endometrium
throughout the menstrual cycle suggests that superoxide plays a key
role in infertility in endometriosis and adenomyosis.
|
|
Adenomyosis--a result of disordered stromal differentiation.
Parrott E, Butterworth M, Green A, White IN, Greaves P.
Medical Research Council Toxicology Unit, Hidgkin Building, Lancaster
Rd., Leicester LE1 9HN, United Kingdom.
|
Am J Pathol 2001 Aug;159(2):623-30 Abstract quote
Adenomyosis is a fairly frequent disorder in adult women characterized
by the haphazard location of endometrial glands and stroma deep within
the myometrium of the uterus.
This study compared the effects on uterine development of the selective
estrogen receptor modulators, tamoxifen, toremifene, and raloxifene
with estradiol when given orally to female mice on days 2 to 5 after
birth. Uterine adenomyosis was found in all (14 of 14) mice dosed
with tamoxifen and most mice (12 of 14) treated with toremifene, but
in none of the vehicle-dosed controls, in only one animal treated
with raloxifene at 42 and 90 days after dosing and in none of the
mice treated with estradiol at 42 days. At 6 days, the uterus in the
groups that developed a high incidence of adenomyosis showed histological
evidence of disturbed differentiation of the myometrium. Gene-expression
XY-scatterplots using Clontech mouse 1.2 Atlas mouse cDNA expression
arrays analyzing total uterine RNA showed nerve growth factor-alpha,
preadipocyte factor-1, and insulin-like growth factor-2 were key genes
differentially modified by tamoxifen or toremifene treatment, relative
to the controls.
As these genes may play an important role in regulating differentiation
and development of the myometrium, these data suggest that adenomyosis
may be caused primarily by defects in the formation of the myometrium.
|
|
Adenomyosis demonstrates increased expression of the basic fibroblast
growth factor receptor/ligand system compared with autologous endometrium.
Propst AM, Quade BJ, Gargiulo AR, Nowak RA, Stewart EA.
Department of Obstetrics, Gynecology, and Reproductive Biology,
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts,
USA.
|
Menopause 2001 Sep-Oct;8(5):368-71 Abstract quote
OBJECTIVES: Basic fibroblast growth factor (bFGF) is an angiogenic
growth factor present in human endometrium and myometrium. Women with
leiomyoma-related abnormal uterine bleeding have local dysregulation
of bFGF and its type 1 receptor (FGF-R). This study was designed to
evaluate if adenomyosis expresses bFGF and FGF-R, and if present,
to compare bFGF and FGF-R expression in adenomyosis and autologous
endometrium.
DESIGN: Menopausal uteri containing endometrium and adenomyosis were
analyzed using immunohistochemistry with monoclonal antibodies specific
for bFGF, FGF-R, and proliferating cell nuclear antigen (PCNA), a
marker of cellular proliferation. The expression and intensity of
staining for bFGF, FGF-R, and PCNA were evaluated in the glandular
epithelium and stroma of adenomyosis and endometrium.
RESULTS: Glandular epithelial staining was significantly greater
in adenomyosis compared with autologous endometrium for bFGF and FGF-R.
Stromal staining for bFGF and PCNA was significantly increased in
adenomyosis compared with autologous endometrium.
CONCLUSIONS: Upregulation of the bFGF receptor/ligand system and
increased cellular proliferation in adenomyosis may contribute to
the pathogenesis of abnormal uterine bleeding associated with adenomyosis.
|
| LABORATORY/
RADIOLOGIC/
OTHER TESTS |
CHARACTERIZATION |
| RADIOLOGIC |
|
| Adenomyosis: prospective comparison of MR imaging
and transvaginal sonography.
Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka
RC, Zeman RK, Simon JA.
Department of Radiology, Georgetown University Medical Center,
Washington, DC 20007. |
Radiology 1994 Mar;190(3):803-6 Abstract quote
PURPOSE: To prospectively compare conventional spin-echo magnetic
resonance (MR) imaging and transvaginal sonography for the diagnosis
of adenomyosis.
MATERIALS AND METHODS: Twenty women with clinically suspected adenomyosis
underwent MR imaging and transvaginal sonography performed within
3 months of each other. Pathologic proof was obtained in all cases.
RESULTS: Seventeen patients were proved to have adenomyosis. The
correct diagnosis was achieved with MR imaging in 15 of 17 cases.
One false-positive and two false-negative diagnoses were made with
MR imaging. With transvaginal sonography, nine of 17 cases of adenomyosis
were correctly diagnosed. One false-positive and eight false-negative
diagnoses occurred. The most frequent cause of false-negative diagnoses
with transvaginal sonography was the misinterpretation of adenomyosis
as leiomyomas (seven cases).
CONCLUSION: MR imaging is significantly better (P < .02) than transvaginal
sonography in the diagnosis of adenomyosis. |
| Transvaginal ultrasound in the diagnosis of diffuse
adenomyosis.
Atzori E, Tronci C, Sionis L.
Department of Obstetrics and Gynecology, Ospedale S. Giuseppe,
Isili, Italy. |
Gynecol Obstet Invest 1996;42(1):39-41 Abstract quote
The purpose of this study is to evaluate the diagnostic capability
of transvaginal ultrasound in detecting diffuse adenomyosis.
One hundred and seventy-five women, mean age 45.8 years (range 37-62),
were studied by TV ultrasound before hysterectomy for benign uterine
pathology. The sonographer diagnosed adenomyosis in 19 patients, whereas
the pathologist diagnosed adenomyosis in 15 women making ex novo diagnoses
in 2 cases. The sensitivity of TV ultrasound was 86.6%, the specificity
96.2%, the positive predictive value 68.4%, and the negative predictive
value 98%.
In conclusion, this study showed that TV ultrasound is an important
and advanced tool in the diagnosis of diffuse adenomyosis. |
| Magnetic resonance imaging and transvaginal ultrasonography
for the diagnosis of adenomyosis.
Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen
F.
Department of Gynecology and Obstetrics, Aarhus University and
Aarhus University Hospital, Aarhus, Denmark. |
Fertil Steril 2001 Sep;76(3):588-94 Abstract quote
OBJECTIVE: To compare the diagnostic potential of magnetic resonance
imaging (MRI) and transvaginal ultrasonography (TVS) in the diagnosis
of adenomyosis.
DESIGN: Double blind set-up.
SETTING: University medical school.
PATIENT(S): We studied 106 consecutive premenopausal women who underwent
hysterectomy for benign reasons.
INTERVENTION(S): Transvaginal ultrasonography and MRI were compared
with histopathologic examination as the golden standard.
MAIN OUTCOME MEASURE(S): Adenomyosis.
RESULT(S): Twenty-two (21%) patients had adenomyosis. The sensitivity
and specificity were as follows: sensitivity: MRI 0.70 (0.46-0.87)
and TVS 0.68 (0.44-0.86) (P=.66); specificity: MRI 0.86 (0.76-0.93)
and TVS 0.65 (0.50-0.77) (P=.03). The combination of MRI and TVS was
most sensitive (0.89 [0.64-0.98]), but produced the lowest specificity
(0.60 [0.44-0.73]). Adenomyosis was not detected by either MRI or
TVS at uterine volumes >400 mL. Exclusion of uteri >400 mL from the
analysis improved the diagnostic precision of MRI, but not that of
TVS. The diagnostic accuracy at MRI was improved by calculating the
maximum difference between the thinnest and thickest junctional zone
(JZdif) (i.e., > or =5-7 mm).
CONCLUSION(S): Magnetic resonance imaging was superior to TVS for
the diagnosis of adenomyosis. Magnetic resonance imaging had a higher
specificity than TVS, but their sensitivities were in line. The diagnostic
accuracy of MRI, as that of TVS, was at an intermediate level, but
the diagnostic accuracy of the former improved by exclusion of uteri
>400 mL. The combination of MRI and TVS produced the highest level
of accuracy for exclusion of adenomyosis, but the low specificity
may necessitate further investigation of positive findings. Measurement
of the difference in junctional zone thickness may optimize the diagnosis
of adenomyosis at MRI. |
| Ultrasonography compared with magnetic resonance
imaging for the diagnosis of adenomyosis: correlation with histopathology.
Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan
S.
Departments of Radiology, Pathology and Obstetrics and Gynecology,
Hopital Tenon, 4 rue de la Chine, 75020, France. |
Hum Reprod 2001 Nov;16(11):2427-33 Abstract quote
BACKGROUND: The objective of this study was to compare the accuracy
of transabdominal (TAUS) and transvaginal sonography (TVUS) and magnetic
resonance imaging (MRI) for the diagnosis of adenomyosis, and to correlate
imaging with histological findings.
METHODS: In a prospective study, 120 consecutive patients referred
for hysterectomy underwent TAUS, TVUS and MRI. Results of these examinations
were interpreted blindly to histopathological findings.
RESULTS: Histological prevalence of adenomyosis and leiomyomas was
33.0 and 47.5% respectively. Adenomyotic uteri were accompanied by
additional pelvic disorders in 82.5% of cases. Sensitivity, specificity,
and positive and negative predictive values of TAUS and TVUS were
32.5 and 65.0%, 95.0 and 97.5%, 76.4 and 92.8%, and 73.8 and 88.8%
respectively. Myometrial cyst was the most sensitive and specific
TVUS criterion. In MRI, the presence of a high-signal-intensity myometrial
spot was as specific but less sensitive than a maximal junctional
zone thickness (JZ(max)) >12 mm and a JZ(max) to myometrial thickness
ratio >40%. Sensitivity, specificity, and positive and negative predictive
values of MRI were 77.5, 92.5, 83.8 and 89.2% respectively. No difference
in accuracy was found between TVUS and MRI, but sensitivity was lower
with sonography in women with associated myomas.
CONCLUSIONS: TVUS is as efficient as MRI for the diagnosis of adenomyosis
in women without myoma, while MRI could be recommended for women with
associated leiomyoma. |
| CLINICAL APPEARANCE
AND GROSS DISEASE |
CHARACTERIZATION |
| ADENOMYOMA |
This describes a focus of adenomyosis within a leiomyoma (fibroid).
Both conditions are common so it is not suprising that this overlap
or collision condition may occur. |
| VARIANTS |
|
| Adenomyosis as a Major Cause for Laparoscopic-Assisted
Vaginal Hysterectomy for Chronic Pelvic Pain
Carter JE, Kong I I.
Women's Health Center of South Orange County, 26732 Crown Valley
Pkwy., Suite 541, Mission Viejo, CA 92691. |
J Am Assoc Gynecol Laparosc 1994 Aug;1(4, Part 2):S6
Abstract quote
Ninety-three women in whom conservative surgical therapy for chronic
pelvic pain failed required hysterectomy for control of their disabling
condition. In 22 of these 93 patients (24%), adenomyosis was the major
pathologic finding. In 10 of the 22 (45%) women who had adenomyosis
and required hysterectomy for control of their pain, tubal ligation
had been previously performed. Only 15% (11/71) of patients without
adenomyosis had had a tubal ligation.
Over 23% of patients requiring hysterectomy for control of chronic
severe pelvic pain had adenomyosis, and almost half of these women
had had a tubal ligation performed. The possible relationship of adenomyosis
to a previous tubal ligation has been explored. |
| Adenomyosis at hysterectomy: a study on frequency
distribution and patient characteristics.
Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani
PG.
Clinica Ostetrica e Ginecologica Luigi Mangiagalli, Department
of Obstetrics and Gynaecology, University of Milano, Italy. |
Hum Reprod 1995 May;10(5):1160-2 Abstract quote
To evaluate the prevalence and risk factors for adenomyosis, the
clinical records of consecutive women undergoing hysterectomy during
a 3 year period were retrieved.
Data were collected on indication for the intervention, general sociodemographic
characteristics of the patients, age at menarche, parity, abortions,
and menopausal status at surgery. Adenomyosis was diagnosed in 332
of the 1334 cases (24.9%). The condition was present in 146 of the
627 patients (23.3%) with fibroids and menorrhagia, 68 of the 265
(25.7%) with prolapse, 21 of the 98 (21.4%) with ovarian cysts, 19
of the 100 (19%) with cervical cancer, 31 of the 110 (28.2%) with
endometrial cancer, 16 of the 57 (28.1%) with ovarian cancer, and
19 of the 77 (24.7%) with miscellaneous indications. These differences
were not statistically significant (chi 2(6) = 11.14). In comparison
with nulliparous women, the odds ratio was 1.3 and 1.5 respectively
in women with one and > or = two births (chi 2(1) trend = 5.76 P <
0.05). No relationship was found between age at surgery, age at menarche,
indications for surgery, menopausal status at intervention, and presence
of endometriosis.
Our findings do not support the notion that adenomyosis is more frequently
related to particular clinical conditions, and suggest that parity
may be associated with an increased frequency of adenomyosis. |
| HISTOPATHOLOGY |
CHARACTERIZATION |
|
Pathologic findings from the Maryland Women's Health Study: practice
patterns in the diagnosis of adenomyosis.
Seidman JD, Kjerulff KH.
Department of Epidemiology and Preventive Medicine, University
of Maryland School of Medicine, Baltimore, USA.
|
Int J Gynecol Pathol 1996 Jul;15(3):217-21 Abstract quote
Criteria for the diagnosis of adenomyosis vary widely in practice.
The reported frequency of adenomyosis in hysterectomy specimens varies
from 5-70% in published series.
In this study, 1252 pathology reports on hysterectomy specimens from
women enrolled in the Maryland Women's Health Study were reviewed.
The frequency of adenomyosis was calculated based on two subgroups:
1114 reports from 15 hospitals, and 705 reports signed by 25 pathologists.
The frequency of diagnosis of adenomyosis ranged from 12% to 58% among
the 15 hospitals, and 10% to 88% among the 25 pathologists. This wide
variation could not be explained by differences in patient age or
number of pregnancies, factors known to correlate with the frequency
of adenomyosis.
These data suggest that adenomyosis may be overdiagnosed. Stringent
and widely accepted criteria for the diagnosis of adenomyosis are
needed, as epidemiologic studies of this common condition would be
facilitated by the use of standard criteria in practice.
|
|
Pathogenetic role of the stromal cells in endometriosis and adenomyosis.
Mai KT, Yazdi HM, Perkins DG, Parks W.
Department of Laboratory Medicine, Ottawa Civic Hospital, Ontario,
Canada.
|
Histopathology 1997 May;30(5):430-42 Abstract quote
Ten cases of endometriosis of bowel, ovaries, uterine serosa and
10 cases of adenomyosis were studied.
Blocks of tissue with areas of interest were submitted for serial
sectioning of the entire block. Some sections were immunostained for
oestrogen receptor, vimentin, Ber-EP-4 and cytokeratins. The common
finding was the presence of type 1 nodules, consisting of isolated
nodules of endometrial stromal cells without endometrial glands, along
blood or lymphatic vessels. The stromal cells showed positive immunoreactivities
for oestrogen receptor and vimentin, and negative reactivities for
cytokeratins. Due to the absence of connection with adjacent endometriosis
or adenomyosis, it is likely that these endometrial stromal nodules
arise from the multipotential pericytes. In addition, in serosa of
all cases of endometriosis, type 2 nodules, having adjacent mesothelium
(Ber-EP4-) changing into epithelium (Ber-EP4+) and type 3 nodules,
with non-endometrial epithelium (oestrogen receptor-) changing into
endometrial gland (oestrogen receptor+) were identified. We believe
that the formation of type 1 nodules from the pericytes and the transformation
of the mesothelium into endometrial glands in type 2 and 3 nodules
are accomplished through the process of induction by the endometrial
stroma, and the proliferation is controlled by genetic, hormonal and
immunological factors.
Type 1, 2 and 3 nodules are likely to represent a histological continuum
in the development of early endometriosis. Subsequent to the formation
of endometriosis in the serosa, the pathway of development of endometriosis
and adenomyosis is similar. Through the processes of induction and
proliferation there is an increase in size of the stroma of type 1
nodules and that of endometrial tissue with subsequent fusion of the
stroma of type 1 nodules and that of foci of adenomyosis or endometriosis.
Consequently, there is enlargement of the stroma of the foci of adenomyosis
or endometriosis. The 'newly enlarged stroma' serves as 'new soil'
for further growth of the endometrial glands in the endometrial tissue.
|
| VARIANTS |
|
| HYPOCELLULAR |
|
|
Adenomyosis with sparse glands. A potential mimic of low-grade
endometrial stromal sarcoma.
Goldblum JR, Clement PB, Hart WR.
Department of Anatomic Pathology, Cleveland Clinic Foundation,
OH 44195.
|
Am J Clin Pathol 1995 Feb;103(2):218-23 Abstract quote
Most cases of adenomyosis are easily recognized by the presence of
intramyometrial aggregates of endometrial glands and endometrial stromal
cells surrounded by hypertrophic smooth muscle.
The authors report seven cases of adenomyosis with sparse glands,
which was a finding that initially caused difficulties in diagnosis
and raised the question of low-grade endometrial stromal sarcoma (LGESS).
The patients' ages ranged from 51 to 81 years. All were postmenopausal.
Each had undergone hysterectomy for a variety of reasons unrelated
to the adenomyosis. Microscopic examination of the uteri disclosed
multiple intramural nests of adenomyotic endometrial stromal cells
without endometrial glands, ranging from 0.5 mm to 8.0 mm in maximum
dimension. The percentage of adenomyotic foci without glands in each
case ranged from 40% to 94%. Two cases also had foci of intravascular
intrusion by the gland-poor adenomyotic stroma.
The most useful features for differentiating adenomyosis with sparse
glands from LGESS include: (1) its occurrence as an incidental finding
in uteri removed for other reasons; (2) the microscopic size of the
adenomyotic foci without grossly evident tumor nodules; (3) a distinctive
concentric zonal organization of the gland-poor stromal aggregates,
with less cellular pale centers surrounded by a thin rim of stromal
or smooth muscle cells with increased cellularity, often with a thicker,
but less well-defined, peripheral zone of hypertrophic myometrial
smooth muscle; (4) the atrophic appearance of the stromal cells and
absence of nuclear atypia and mitotic figures; (5) an absence of sclerotic
areas, foam cells, sex cordlike structures, hemangiopericytoma-like
vascular pattern, prominent vascular invasion and extrauterine extension
commonly found in LGESS; (6) the presence of typical adenomyosis with
glands elsewhere in the myometrium; and (7) the postmenopausal age
of the patient.
|
| VASCULAR |
|
|
Morphometric evaluation of stromal vascularization in the endometrium
in adenomyosis.
Ota H, Igarashi S, Tanaka T.
Department of Obstetrics and Gynecology, Akita University School
of Medicine, Japan.
|
Hum Reprod 1998 Mar;13(3):715-9 Abstract quote
A computerized morphometric investigation of stromal vascularization
in the endometrium during adenomyosis was performed retrospectively.
Using a polyclonal antibody and a peroxidase-antiperoxidase method,
formalin-fixed paraffin sections of the tissue were stained for von
Willebrand factor, a marker for endothelium. The subjects were divided
into two groups: 42 patients with histologically proven adenomyosis
and 29 fertile control subjects, 12 in the proliferative phase and
17 in the secretory phase. Objective quantitative colour image analysis
was used to assess the staining intensity and hence the degree of
vascularization. In the control group, stromal vascularization increased
in the secretory phase.
In adenomyosis, vascularization increased markedly, up to 11.6 times
that of the controls, in terms of the in total surface area of capillaries
per mm2 in the endometrium in the proliferative phase. These findings
suggest clinical relevance to severe functional disturbances such
as hypermenorrhoea or iron deficiency anaemia.
|
| SEX-CORD STROMA |
|
|
Adenomyosis with a sex cord-like stromal element.
Fukunaga M.
Department of Pathology, The Jikei University School of Medicine,
Tokyo, Japan.
|
Pathol Int 2000 Apr;50(4):336-9 Abstract quote
A case of adenomyosis with a sex cord-like stromal element is described.
The element was an incidental, solitary, microscopic finding in a
focus of adenomyosis. It was characterized by cord and trabecular
arrangements of round to polygonal shaped cells in the endometrioid
stroma. The cells were immunohistochemically positive for desmin and
alpha-smooth muscle actin but negative for sex cord markers (alpha-inhibin
and O13).
The element appears to originate from the endometrial stromal cells
through smooth muscle metaplasia.
|
| PROGNOSIS AND TREATMENT |
CHARACTERIZATION |
| PROGNOSTIC FACTORS |
|
|
Successful pregnancy in a series of patients with adenomyosis.
Nezhat CH, Kane L, Abolfathian P, Nezhat FR, Nezhat CR.
Stanford University School of Medicine, Atlanta, GA, USA
|
Obstet Gynecol 2001 Apr;97(4 Suppl 1):S22 Abstract quote
Objective: To report the surgical technique and pregnancy outcome
in a series of patients with adenomyosis.
Methods: This is an observational study of patients who underwent
laparoscopy or laparoscopically assisted cytoreductive surgery for
symptomatic enlarged uterus due to uterine myoma or adenomyosis or
both who desired to preserve their reproductive system.
Results: We present a series of nine patients-mean age 36.2 years
(range, 31-41 years), mean gravida 1.7, para 0.3, with histologically
confirmed adenomyosis or ademyoma-who achieved pregnancy. The average
length of time from surgery to conception was 6.9 months (range, 3-14).
One patient was treated preoperatively with danazol (case 1); one
with nafarelin acetate (case 2); and two with oral contraceptive pills
(cases 4, 6). Five patients conceived spontaneously (cases 2, 4, 5,
7, 9). Two patients used clomiphene citrate and intrauterine insemination
(cases 1, 3); one used clomiphene citrate and timed intercourse (case
8). Case 6 had in vitro fertilization. Five patients carried to term
(cases 1, 2, 3, 4, 8); one had a cesarean birth at 36 weeks, delivering
twins (case 6); one is currently in the second trimester (case 5);
and two patients had missed abortion at 12 and 9 weeks (cases 7, 9).
The most common associated pathologies were endometriosis (56%), adhesions
(56%), and leiomyomata (22%).
Conclusion: Adenomyosis theoretically is associated with infertility,
and hysterectomy has been considered the treatment of choice. However,
previous anecdotal case reports and our series indicate that in patients
with adenomyosis who desire pregnancy, there is a good chance for
successful pregnancy after cytoreductive surgery.
|
| MALIGNANCY |
|
| Adenocarcinomas Arising from Uterine Adenomyosis: A
Report of Four Cases
Masafumi Koshiyama; Akira Suzuki; Mitsuru Ozawa; Kohei Fujita;
Atsuko Sakakibara; Makoto Kawamura; Shugen Takahashi; Haruko Fujii;
Takeshi Hirano; Atsuhiko Okagaki; Tadayoshi Nagano; Chiaki Ban
From the Department of Obstetrics and Gynecology (M.K., A.S.,
M.O., K.F., A.S., M.K., S.T., H.F., T.H., A.O., T.N., C.B.), Osaka
National Hospital, Chuoku, Osaka 540-0006, Japan, and the Department
of Obstetrics and Gynecology (M.Ko.), Himeji National Hospital, Himeji
City, Hyogo 670-8520, Japan.
|
Int J Gynecol Pathol 2002 Jul;21(3):239-45 Abstract quote
Adenocarcinomas arising from adenomyosis uteri are rare.
This study reports four such cases and characterizes them clinically
and microscopically. In all four patients, the endometrial cytology
was negative, and MR imaging and ultrasound sonography did not detect
the tumors preoperatively.
The histological subtypes of the four tumors
were endometrioid (one grade 1, one grade 3), serous, and clear cell.
In three cases, the adenocarcinomas were present exclusively in the
myometrium, and a transition between the carcinomas and the adenomyotic
glands was observed in all cases. The eutopic endometrium was normal
except in one case in which there was a small focus of invasive carcinoma.
In two of four cases, pelvic or paraaortic lymph node metastases were
present. In the carcinomas, ER immunoreactivity was not found in any
tumor and PR positivity was found in only one tumor. In contrast,
p53 immunopositivity was found in three of four carcinomas.
Adenocarcinomas arising from adenomyosis are difficult to diagnose
preoperatively, and their aggressive behavior in some cases seems
to be related to the histological subtype.
|
Endometrioid adenocarcinoma arising from adenomyosis: report and immunohistochemical analysis of an unusual case.
Sasaki T, Sugiyama T, Nanjo H, Hoshi N, Murakami M, Sugita A, Takahashi M, Kawamura K, Ono I, Masuda H.
Department of Pathology, Nakadori General Hospital, Yokohama, Japan. |
Pathol Int 2001 Apr;51(4):308-13 Abstract quote
A case of endometrioid adenocarcinoma arising from adenomyosis is reported. The patient was a 53-year-old woman who complained of vulvar itching.
Smear cytology of the endometrium revealed adenocarcinoma. Magnetic resonance imaging of the pelvis revealed a lesion with a slightly high intensity in the uterine fundus on a T2-weighted image. Semiradical total hysterectomy and bilateral adnexectomy were performed, followed by chemotherapy. Histologically, the lesion in the uterine fundus was composed mostly of adenocarcinoma with stromal invasion. There were many adenomyotic foci in and around the carcinoma, including some showing transition to adenocarcinoma. There was no malignant finding in the normally situated endometrium. The carcinoma invaded in the myometrium, involving the uterine serosa, but no dissemination to the peritoneal cavity was found.
The carcinoma was, therefore, considered to be endometrioid adenocarcinoma arising from adenomyosis. Immunohistochemistry showed expression of p53 oncoprotein and Ki-67 antigen in the carcinoma cells. The value of immunohistochemistry in predicting prognosis is discussed. |
Endometrioid adenocarcinoma arising from adenomyosis.
Takai N, Akizuki S, Nasu K, Etoh Y, Miyakawa I.
Department of Obstetrics and Gynecology, Oita Medical University, Hasama-machi, Oita, Japan |
Gynecol Obstet Invest 1999;48(2):141-4 Abstract quote
In spite of many references to carcinoma arising from endometriosis at extrauterine sites, there are few documented cases of carcinoma developing in association with adenomyosis.
We present 2 rare cases of adenocarcinoma arising from adenomyosis. The relationship between prior frequent estrogen use and carcinogenesis and the possible effects of chemotherapy and radiation therapy are reviewed. |
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Live birth after conservative surgery for severe adenomyosis following
magnetic resonance imaging and gonadotropin-releasing hormone agonist
therapy.
Ozaki T, Takahashi K, Okada M, Kurioka H, Miyazaki K.
Department of Obstetrics and Gynecology, Shimane Medical University,
Izumo, Japan.
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Int J Fertil Womens Med 1999 Sep-Oct;44(5):260-4 Abstract quote
This is a report of a live birth after conservative surgery for severe
adenomyosis following diagnosis by MRI and therapy with GnRH-a.
A 33-year-old gravida 1 para 1 woman with a 5-year history of secondary
infertility received a gonadotropin-releasing hormone agonist (GnRH-a),
leuprolide acetate, for 16 weeks to control symptoms of severe adenomyosis
and to treat infertility. However, severe dysmenorrhea recurred after
the discontinuation of therapy. Because an elevated serum level of
CA-125 and MRI findings suggested that she was experiencing a relapse
of adenomyosis, GnRH-a therapy was re-instituted. After 24 weeks of
the second therapy, her uterus decreased to normal size and an MRI
revealed a localized low-signal-intensity myometrial mass with well-defined
borders.
We easily resected the localized lesion of adenomyosis using the
same technique used to treat uterine leiomyoma. The patient became
pregnant after 12 weeks of additional danazol therapy. A healthy male
infant was delivered at term by cesarean section.
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