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Uterine Adenomyoma

Uterus Adenomyoma

Uterine adenomyoma is a benign mass formed by the invasion of the myometrium by endometrial cells. Adenomyoma is a focal part of the related diffuse condition called adenomyosis. Treatment may be surgical (excision of the mass alone, or hysterectomy for women who do not wish to become pregnant), or medical by administration of gonadotropin-releasing hormone agonists.


Presentation

Uterine adenomyoma is a collection of endometrial glands, which are bordered by two consecutive layers of cells, the first derived from endometrial stroma and the second, outermost one, formed by leiomyomatous smooth muscle cells. Adenomyoma is believed to develop with endometrial glandular and stromal cells invading the myometrium [1]. Adenomyosis is defined in a similar way, but it affects a larger region of the uterus. Adenomyoma is regarded by some as a focal region within the larger area of adenomyosis, and by others as a different version of the condition. Adenomyoma may be difficult to distinguish from uterine fibroids.

Adenomyoma is not a frequent uterine lesion. Of the samples obtained by hysterectomy, twenty percent show evidence of adenomyosis, but the solid focal forms, i.e. adenomyomas, are rare [2], and the cystic forms even more so. Adenomyomas are usually firm [3], but can sometimes be soft. Most identified adenomyomas are in the corpus of the uterus [3] [4]. In one study close to 50% of the patients with adenomyomas also had fibroids [3]. Adenomyomas may be polypoid, - as was the case in an older woman treated with tamoxifen for breast cancer [5]- or may present as cystic lesions, either adult or juvenile type [1] [2]. Decidualization of adenomyomas has also been observed in a pregnant woman [6].

The most frequent symptoms are abnormal vaginal bleeding [3], chronic pelvic pain, and dyspareunia [7]. Serious cases may lead to infertility. Cystic forms of adenomyoma are characterized by severe dysmenorrhea [1] [2]. These symptoms also accompany other conditions that can coexist with adenomyomas, such as uterine fibroids and endometriosis [8].

Vaginal Bleeding
  • bleeding is the most common presenting feature Terminology Adenomyoma, cystic adenomyoma, polypoid adenomyoma Clinical features Presents as abnormal vaginal bleeding Severe cases in young women can manifest with infertility Diagnosed with radiology and[pathologyoutlines.com]
  • The most frequent symptoms are abnormal vaginal bleeding, chronic pelvic pain, and dyspareunia. Serious cases may lead to infertility. Cystic forms of adenomyoma are characterized by severe dysmenorrhea.[symptoma.com]
  • Two presented with abnormal vaginal bleeding, but, in most patients, the cervical tumors did not cause symptoms.[ncbi.nlm.nih.gov]
  • The most common presenting symptom was abnormal vaginal bleeding (n 15). Thirteen patients underwent panhysterectomy; 7, total hysterectomy; 1, subtotal hysterectomy; 4, polypectomy or tumor removal; and 1, curettage.[ncbi.nlm.nih.gov]

Workup

Clinical diagnosis is not feasible since the symptoms are not specific. Adenomyomas are characterized histologically. Histopathologic examination of biopsies reveals lesions consisting of glands and cysts surrounded by endometrial epithelium, stroma, and smooth muscle cells. Distinguishing adenomyoma from atypical polypoid adenomyoma or adenosarcoma may be problematic [4]. An adenomyoma invaded by lymphocytes has been described that structurally resembled a lymphoma, and might have been misdiagnosed as such [9].

A suspicion of adenomyosis (including adenomyomas) is usually first followed up by ultrasound techniques. Transabdominal sonography has a sensitivity of only 32.5%– 63% [10] and is not regarded as a dependable method [11], but transvaginal sonography shows higher accuracy in diagnosis [10]. According to some sources [12], transvaginal sonography can be as sensitive as magnetic resonance (MR) imaging. A hysterosalpingogram can detect the expansion of diverticula into the myometrium [13]. Computed tomography cannot satisfactorily diagnose adenomyosis, or differentiate it from fibroids.

Changes in the thickness of the endometrium-myometrium junctional zone are characteristic of both diffuse and focal forms of adenomyosis. The thickness of the junctional zone can be examined by both two- or three dimensional transvaginal ultrasound or by MR imaging; a junctional zone thicker than 12 mm indicates adenomyosis. Adenomyoma, situated in the myometrium, has a round shape and low signal intensity on T2 weighted MR imaging, but often with small regions of high intensity [7].

Treatment

  • Surgery followed by six-course treatment (n 114, surgical-medical group) or no treatment (n 51, surgery-alone group) with a gonadotropin-releasing hormone (GnRH) agonist regimen.[ncbi.nlm.nih.gov]
  • The 18 subjects were retrospectively divided into treatment group (achieving this pregnancy by treatment; 10 cases) and control group (having no difficulty conceiving; 8 cases).[ncbi.nlm.nih.gov]
  • In the clinical parterre, novel methods of conservative treatments have been developed to allow many women to keep their reproductive capacity and to save uterus, and more novel treatments are available on the horizon.[books.google.com]
  • Hysterectomy, through either exploratory laparotomy or minimally invasive procedures, is a definite treatment for uterine adenomyosis, once the women have completed childbirth or do not require future fertility.[tmu.pure.elsevier.com]

Prognosis

  • […] cystic change the region may also have a striated appearance 5 T1 C (Gd) contrast-enhanced MRI evaluation is usually not indicated for evaluation of adenomyosis, however, if performed, it shows enhancement of the ectopic endometrial glands Treatment and prognosis[radiopaedia.org]
  • In cases of advanced cancer, pre-operational chemotherapy, in which the patient receives chemotherapy before going through the operation, is actively performed in order to improve the prognosis.[kasumi-hosp.jp]
  • Diagnosis and prognosis of leiomyosarcomas . Arch Pathol 1966; 82 : 40–4. 3. Kempson R , Bari W . Uterine sarcomas: classification, diagnosis and prognosis . Hum Pathol 1970; 1 : 331–49. 4. O'Connor D , Norris H .[nature.com]

Etiology

  • Three theories have been offered to explain their etiology: 1) the uterine/Mullerian duct fusion defect theory, which is based on a developmental abnormality occurring during the formation of the female genital tract, 2) the metaplastic theory, which[jpatholtm.org]
  • Etiologies of Acute Abnormal Uterine Bleeding The etiologies of acute AUB, which can be multifactorial, are the same as the etiologies of chronic AUB.[acog.org]
  • The diagnosis of uterine adenomyoma is usually straightforward, but occasional cases create diagnostic difficulty, and malignancies of epithelial or mesenchymal origin may be considered. [4] Two theories have been offered to explain the etiology of the[ccij-online.org]

Epidemiology

  • Although the two diseases have distinct epidemiological features, they have the same 'target tissue' for hormonal therapy, namely ectopic endometrium.[2womenshealth.com]
  • Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd . 2013;73(9):924–931. [PMID:24771944] Exacoustos C, Manganaro L, Zupi E.[unboundmedicine.com]
  • Epidemiological data indicate that parity, caesarean section, induced abortion, dilatation and curettage, uterine malformation and late age at menarche may be the risk factors for adenomyosis development. [1] The need for hysterectomy to diagnose adenomyosis[jebmh.com]
  • Epidemiology Adenosarcoma occurs in females aged 15-90 years, with a median age at diagnosis of 58 years. [2, 3 , 4, 5 , 6, 7 , 8, 9 ] Most patients diagnosed with adenosarcoma are postmenopausal, but one third are of reproductive age.[emedicine.medscape.com]
  • Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol . 2006;20(4):465–477. 3. Rabinovici J, Stewart EA. New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol . 2006;20(4):617–636. 4.[dovepress.com]
Sex distribution
Age distribution

Pathophysiology

  • Recent research on the genomics and molecular biology of myomas has enabled us to better understand the pathogenesis and pathophysiology of this benign tumor, but more remains to be discovered.[books.google.com]
  • Aetiology & Pathophysiology Adenomyosis describes the presence of endometrial tissue with the myometrium of the uterus.[teachmeobgyn.com]
  • Etiology and Pathophysiology Adenomyosis has been described as an abnormal ingrowth and invagination of the basal endometrium into the inner layer of the myometrium (junctional zone [JZ]).[unboundmedicine.com]
  • ., Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynaecol, 2006. 20(4): p. 493-502.[en.wikipedia.org]
  • The pathophysiology of uterine adenomyosis: an update. Fertil Steril . 2012;98(3):572–579. 5. Benagiano G, Brosens I. The endometrium in adenomyosis. Womens Health (Lond Engl) . 2012;8(3):301–312. 6.[dovepress.com]

Prevention

  • Current medical research has not established a way of preventing Adenomyoma of Uterine Corpus.[dovemed.com]
  • Uterine artery embolization This is a procedure that prevents certain arteries from supplying blood to the affected area. With the blood supply cut off, the adenomyosis shrinks.[healthline.com]
  • Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep 2010;59(RR-4):1–86. [PubMed] [Full Text] Update to CDC’s U.S.[acog.org]

References

Article

  1. Kim MJ. A case of cystic adenomyoma of the uterus after complete abortion without transcervical curettage. Obstet Gynecol Sci. 2014 Mar;57(2):176-179.
  2. Chun SS, Hong DG, Seong WJ, Choi MH, Lee TH. Juvenile cystic adenomyoma in a 19-year-old woman: a case report with a proposal for new diagnostic criteria. J Laparoendosc Adv Surg Tech A. 2011;21:771-774.
  3. Tahlan A, Nanda A, Mohan H. Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature. Int J Gynecol Pathol. 2006 Oct;25(4):361-365.
  4. Gilks CB, Clement PB, Hart WR, Young RH. Uterine adenomyomas excluding atypical polypoid adenomyomas and adenomyomas of endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites. Int J Gynecol Pathol. 2000 Jul;19(3):195-205.
  5. Nasu K, Arima K, Yoshimatsu J, Miyakawa I. Adenomyomatous polyp of the uterus in a patient receiving tamoxifen. Jpn J Clin Oncol. 1997 Oct;27(5):350-352.
  6. Terada T. Decidualization of uterine adenomyoma in a pregnant woman: a case report with immunohistochemical study. Arch Gynecol Obstet. 2015 Feb;291(2):399-402.
  7. Graziano A, Lo Monte G, Piva I, et al. Diagnostic findings in adenomyosis: a pictorial review on the major concerns. Eur Rev Med Pharmacol Sci. 2015 Apr;19(7):1146-1154.
  8. Silverberg S, Kurman R. Tumor-like lesions. In: Rosai J, ed. Tumors of the uterine corpus and gestational trophoblastic disease, fasc 3, ser 3. Washington, DC: Armed Forces Institute of Pathology, 1992; 210 –212.
  9. Wei S, Feng R, Cui Q, Luo Y, Zhang S. Uterine adenomyoma with lymphoid infiltration simulating lymphoma. Gynecol Oncol. 2004 Nov;95(2):409-411.
  10. Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics. 2005 Jan-Feb;25(1):21-40.
  11. Reinhold C, Tafazoli F, Wang L. Imaging features of adenomyosis. Hum Reprod Update 1998; 4:337–349.
  12. Exacoustos C, Brienza L, Di Giovanni A, et al. Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol 2011; 37: 471-479.
  13. Verma SK, Lev-Toaff AS, Baltarowich OH, Bergin D, Verma M, Mitchell DG. Adenomyosis: sonohysterography with MRI correlation. AJR Am J Roentgenol. 2009 Apr;192(4):1112-1116.

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Last updated: 2018-06-22 05:02