Adenomyosis

Clinical assessment of the general status of patients with combined uterine pathology (leiomyoma (LM) and adenomyosis) has a practical importance for determining specific therapeutic tactics. The study of the general condition of reproductive aged women with this pathology allows determining of many factors that can affect the clinical course of disease.

Purpose of the study was to investigate the clinical status of reproductive aged women who suffer from combined uterine pathology – LM and adenomyosis.

Materials and methods. 120 women of reproductive age were examined. Group IA united 60 patients with combined uterine pathology – asymptomatic LM and nodal, diffuse, diffuse-focal adenomyosis III, IV degrees of severity with active clinical course; group IB united 60 patients with combined uterine pathology - symptomatic LM and diffuse, diffuse focal adenomyosis I, II degrees of severity with inactive clinical course. Examination was carried out in accordance with the orders of the Ministry of Health of Ukraine.

Results. A study of the general status of reproductive aged women has revealed many factors that can affect the clinical course of disease. The study of nosological forms of extragenital pathology revealed a wide range of different organs and systems diseases, co-morbidities of mainly chronic course, varying severity in 100% of women. A number of somatic diseases can be both a cause and a consequence of gynecological pathology, especially hormonal etiology. Analysis of the anamnestic data on the transferred gynecological diseases showed 100% frequency of the combined and concomitant pathology of the female genital tract.

Conclusions. Completed study involving reproductive aged women with combined uterine pathology (LM and adenomyosis) showed many factors that can affect the clinical course of disease. Obtained data indicate that there are complex metabolic disorders in the women’s body suffering from that combined uterine pathology.

OBJECTIVE:

Recent studies report a link between endometriosis and ovarian cancer (OC). Using a population-based cohort study to confirm the association between endometriosis and cancer is desirable. We thus examined the magnitude of the risks of OC, endometrial cancer (EC), breast cancer, colorectal cancer (CRC), and other cancers in women with newly diagnosed endometriosis or adenomyosis (internal endometriosis).

METHODS/MATERIALS:

Women older than 20 years with claims data between 2003 and 2005 were identified from the Longitudinal Health Insurance Dataset containing 1 million individuals randomly sampled from the National Health Insurance Research Database. Those with preexisting malignancies, hysterectomy, or oophorectomy were excluded. The endometriosis cohort (n = 2266, including 768 cases of pure adenomyosis) and comparison cohort (n = 9064), formed by 1:4 matching, were followed up until incidence cancer, dropout, or December 31, 2008. Outcome measures included cancer incidence and adjusted hazard ratio by Cox model adjusted for age group, comorbidities, and endometriosis medication use.

RESULTS:

With 9842 person-years of follow-up in endometriosis cohort and 36,274 person-years of follow-up in comparison cohort, there were increased risks of all cancers (adjusted hazard ratio, 1.8; 95% confidence interval, 1.4-2.4), OC (4.56, 1.72-12.11), and EC (4.05, 1.20-13.66). The ovarian endometriosis group was associated with increased risk of subsequent OC (4.37, 1.07-17.83). The adenomyosis group was strongly associated with both OC (5.50, 1.95-15.50) and EC (5.13, 1.36-19.40). Increased risk of subsequent CRC was observed in women with adenomyosis with coexistent endometriosis at other sites (13.04, 2.21-77.04). However, no statistically significant increased risk of breast or other cancers was observed.

CONCLUSIONS:

Having limitations such as lacking of parity information which may affect the magnitude of risk estimates, this study demonstrates that ovarian endometriosis has a 4-fold increased risk of OC. Adenomyosis may associate with a 4- to 5-fold increased risk of OC and EC, and unexpectedly, a 13-fold increased risk of CRC.

table of contents † Introduction † Methods † Results Basic mechanisms of migration and invasion ESC migration and endometriosis ESC migration and adenomyosis ESC migration and endometrial regeneration ESC migration and embryo implantation ESC migration and early pregnancy loss Signalling pathways in ESC migration † Clinical perspectives and emerging concepts † Conclusion

Aims and objectives: The aim of this study was to explore patient experiences and perceptions of adenomyosis. Background: Adenomyosis is a benign gynaecological disease characterised by abnormal presence endometrial tissue (the inner lining of the uterus) within the myometrium (the think muscular wall of the uterus).To date there is little data that reflects the experiences and perceptions of women with adenomyosis. Nevertheless, there is an abundance of Internet-based discussion forums and support groups related to women's health which provide a low-cost resource for support and assessing patient experiences. Methods: A qualitative explorative approach was used to look at the experiences and perceptions of women with adenomyosis. Online comments posted between September 2013 and August 2014 were scanned and then women were invited to volunteer and participate in a closed discussion group where data was analyzed for thematic content. Results: Three broad categories emerged from the discussion group: reassurance of finding others with the same health issues and supportive communication; length of time associated condition and diagnosis; challenges faced on a daily basis living with adenomyosis. Data revealed particular concerns for women with adenomyosis: length taken for diagnosis and treatment, wide variations in treatment experienced, healthcare practitioners' views and treatment options varied widely and the loneliness felt by women. Conclusions: Online communities may provide information and support about topics that concern women and offers an alternative arena to discuss issues, such as pain experienced, medication, treatment options and side effects. Data highlighted potential issues that may not be a priority to healthcare practitioners but are nevertheless important to patients. Relevance to clinical practice: Despite the growing use of online health-related communities, there is little researching to how online communities can contribute to patient support in identifying patient issues regarding diagnosis, early treatment and ongoing care, provision and service development.

Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organ...

We report a rare case of spontaneous uterine rupture of an unscarred uterus caused by adenomyosis in the early third trimester. A 33-year-old primigravid woman was referred to our department because of severe acute abdominal pain and signs and symptoms of hemorrhagic shock. Ultrasound exanimation performed at admission revealed a living, intrauterine fetus of 28 weeks gestational age with reduced amniotic fluid and presence of free peritoneal fluid. The fetal heart rate was non-reassuring with variable decelerations and severe fetal bradycardia. Emergency cesarean section revealed massive hemoperitoneum and complete rupture in the uterine fundus. Subtotal peripartum hysterectomy with conservation of adnexae was performed. Histological examination revealed adenomyosis at the site of uterine rupture.

Tujuan : Untuk mengetahui  derajad nyeri dan kekambuhan kembali  dismenorhea berat setelah tindakan laparoskopi adenomiomektomi pada pasien fokal adenomiosis yang tidak respon terhadap  pengobatan medikamentosa.
Metode : Penelitian ini merupakan penelitian Kohort-Retrospective pada pasien dengan kriteria inklusi adenomiosos fokal dengan derajad VAS dismenorhea 9/10 yang gagal terapi dengan obat hipoestrogen. Dilakukan pemantauan setelah tindakan laparoskopi adenomiomektomi dan  pemberian GnRh analog setiap bulan selama 6 bulan dan kemudian di pantau setiap 3 bulan untuk derajad VAS  untuk dismenorhea selama 24 bulan kemudian.
Hasil : Dari 92 pasien (2012 – 2017) yang dilakukan laparoskopi adenomiomektomi, didapatkan 68,4 % terjadi penurunan VAS dismenorhea secara signifikan, 14,1 % terjadi kekambuhan kembali pada 12 bulan  paska tindakan dan 1 % fluktuatif. Dengan rerata VAS dismenorhea antara  0.447 sampai 0.894 dalam rentang waktu 24 bulan paska tindakan. Didapatkan 13 pasien dengan kehamilan spontan dengan 21 % berakhir dengan abortus,  3 % melahirkan pervaginam dan hanya 1 % terjadi ruptura uteri pada trimester 2 kehamilan
Kesimpulan : Laparoskopi adenomiomektomi dapat menjadi alternative terapi pada pasien adenomiosis dengan nilai VAS dismenorhea 9/10  yang gagal terapi hypoestrogen dan menginginkan fertilitas.
Kata kunci : Adenomiosis, Dismenorhea, Laparoskopi, Adenomiomektomi.

Adenomyosis is a benign pathology with a marked impact on women in reproductive age. The prevalence of adenomyosis ranges from 5 to 70%. Dysmenorrhea, metrorrhagia, chronic pelvic pain, dyspareunia and infertility often occur, while a third of the women is asymptomatic. This pictorial review focuses on the peculiar patterns of presentation in adenomyosis. They are identified by means of non-invasive or minimally invasive techniques, with particular reference to 2D- and 3D-transvaginal sonography, sonohysterosalpingography, magnetic resonance imaging, and endoscopic techniques (i.e. hysteroscopy and laparoscopy).

Objectives. To determine the prevalence of ultrasound features suggestive of adenomyosis in women undergoing surgery for endometriosis compared with a control group of healthy women without endometriosis. Methods. Retrospective case-control study comparing women with intractable pain or infertility, who underwent transvaginal ultrasound and subsequent laparoscopic surgery, with a control group of healthy women without a previous history of endometriosis. A diagnosis of adenomyosis on TVUS was made based on asymmetrical myometrial thickening, linear striations, myometrial cysts, hyperechoic islands, irregular endometrial-myometrial junction, parallel shadowing, and localized adenomyomas and analyzed for one sign and for three or more signs. Results. The study and control groups included 94 and 60 women, respectively. In the study group, women were younger and had more dysmenorrhea and infertility symptoms. The presence of any sonographic feature of adenomyosis, as well as three or mo...

Background: This study was carried out to assess the clinical effectiveness of levonorgestrel releasing intrauterine device (LNG-IUS) in the treatment of menorrhagia due to either Dysfunctional Uterine Bleeding (DUB) or fibroid in Indian patients, and to assess patient satisfaction with this treatment modality. Methods: Sixty women with menorrhagia, 30 due to fibroid and 30 due to DUB, meeting inclusion criteria, received LNG-IUS and were prospectively followed up for 9 months with periodic clinical assessments and transvaginal ultrasounds. Patient satisfaction was assessed on a five-point scale. Results: One patient in DUB group was lost to follow-up. In DUB patients, the treatment failure rate was only 3.4% (1 out of 29 patients). The median PBAC score reduced by 95% at 9 months. Fibroid patients also had an equally impressive 97.7% reduction of PBAC score at 9 months, although the failure rate was higher (23.3%; 7 out of 30). Majority of patients were either "very satisfied" or "satisfied" with the treatment, although this percentage was more in DUB (82.8%) than in the fibroid group (66.7%). Haemoglobin and serum ferritin levels significantly increased in both groups. No major side effect was noted. Conclusions: LNG-IUS is an excellent treatment modality for patients of DUB, with good patient satisfaction. It is also a useful treatment option in non-submucosal small fibroids for the symptoms of menorrhagia, can reduce uterine volume and can help avoid hysterectomy, but there is no effect on fibroid volume. Majority of patients are satisfied, although satisfaction rates are less than in DUB patients.

Hysterectomy is the most commonly performed gynecological
surgery throughout the world. Few studies have been performed
describing the pathologic findings in hysterectomy specimens and
examining the relationship between the preoperative clinical indication
and pathologic diagnosis. This study was undertaken to identify
the most common pathological lesion in hysterectomy specimens.
This study was done in a medical college hospital of Bangladesh
over a period of two years and two hundred and two hysterectomy
specimens were included. Surgical specimens were formalin fixed
and tissue was adequately processed from them. The sections were
stained routinely with hematoxylin and eosin stain. Pathological
findings in the uterus, cervix, ovaries and tubes were noted. Menorrhagia,
fibroid uterus and uterovaginal prolapsed were the most
common clinical indications for hysterectomy. The most common
pathologies identified were atrophic endometrial in endometrial,
leiomyoma in myometrium, chronic cervicitis in cervix, benign cystic
teratoma in ovaries and salpingitis in fallopian tubes. The pathologic
examination confirmed the clinical diagnosis in majority of the cases.
Keywords: Histopathology; Hysterectomy; Leiomyoma; Prolapse

Background: The aim of the study was to assess the accuracy of ultrasound shear wave elastography in the diagnosis of adenomyosis. Methods: One hundred and fifty three patients were examined. Ninety-seven patients were with suspected adenomyosis and 56 patients were with unremarkable myometrium. Adenomyosis was confirmed in 39 cases (A subgroup) and excluded in 14 cases (B subgroup) in the main group based on morphological examination. All patients underwent ultrasound examination using an Aixplorer (Supersonic Imagine, France) scanner with application of shear wave elastography during transvaginal scanning. Retrospective analysis of the elastography criteria against the findings from morphological/histological examination was performed. Results: The following values of Young's modulus were found in subgroup A (adenomyosis):

Introduction and hypothesis Adenomyosis causes problems in women, including dysmenorrhea and abnormally heavy and prolonged menstrual bleeding; however, its etiology is unknown. We hypothesized that urinary symptoms are frequent in patients with adenomyosis and that they affect the patients' quality of life. Methods We conducted a pilot study from September 2011 to December 2011. Ninety-one patients with an ultrasound diagnosis of uterine adenomyosis comprised the study group (adenomyosis group). Ninety-four women with a normalappearing uterine myometrium on ultrasound comprised the control group. Patients filled out two validated questionnaires, the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Patients also underwent a pelvic examination and urinary symptoms were recorded. Groups were compared using the nonparametric Mann-Whitney U test, chi-square test, and Fisher's exact test. Results The frequency of urinary symptoms was significantly higher in the adenomyosis group than in the control group (P0 0.0001), including stress urinary incontinence, urgency, daytime frequency, urge urinary incontinence, and dyspareunia. Total UDI scores were significantly higher in the adenomyosis group than those in the control group (P<0.0001), as were IIQ scores of questions regarding social relations (P<0.05). Conclusions Our results suggest that urinary tract dysfunction is associated with adenomyosis and that urinary symptoms may affect patients' quality of life.

The objectives of this study were: (i) to evaluate the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on both proliferation and apoptosis markers and hormone receptors of the eutopic and ectopic endometrium of women experiencing pain related to endometriosis and (ii) to compare the results with those obtained with GnRH agonist (GnRHa) injections. methods: Pre-and post-treatment endometrium and endometriosis specimens were obtained from 22 women experiencing pain related to endometriosis who were treated with LNG-IUS (n ¼ 11) or GnRHa (n ¼ 11) for 6 months. Changes in the expression of proliferating cell nuclear antigen, Fas, progesterone receptor (PRA) and estrogen receptor a (ER-a) were analyzed by immunohistochemistry. results: The cell proliferation index was significantly reduced in the epithelium and stroma of both the eutopic and the ectopic endometrium after treatment with the LNG-IUS and GnRHa. Only LNG-IUS users showed an increased H-score for Fas in the epithelium of the eutopic and ectopic endometrium (P , 0.05). Expression of ERa and PRA by the glandular epithelium was lower in the eutopic endometrium after both treatments, but this reduction was noted in the ectopic endometrium only after LNG-IUS treatments (P , 0.05). No difference was detected between groups for any of the markers. conclusions: LNG-IUS reduced both cell proliferation and the expression of PRA and ERa and increased Fas expression in the eutopic and ectopic endometrium of patients with endometriosis. Some of these actions were not observed with GnRHa.

Adenomyosis is characterized by polymorphism of clinical manifestations and is the cause of chronic pelvic pain associated with endometriosis in 53–80% of cases. Heavy dysmenorrhea in adenomyosis is a key factor that reduces the quality of life and, moreover chronic pain reduces stress resistance and launches the rehabilitation cytokines cascade, which causes exacerbation of endometriosis. Formation of painful syndrome with adenomyosis may be due to: changes in neurohumoral regulation, stimulation of nerves and blood vessels growth and myometrium inflammatory remodeling against the background of circulatory disorders and vascular sclerosis. These processes lead to violation of neuroimmune relationships that determine the increase in the number and sensitivity of nociceptors against the background of the chronic immuno-inflammatory process in endometrials and myometry.
Experimental studies have shown that the supraspinal role of the nitric oxide (NO) is to indirect mechanical nociceptive reflexes. The dose-dependent L-arginine role in the pain syndrome formation also was shown; it was found that small doses of L-arginine lead to the activation of nNO-synthase and analgesic effect. Large doses are activated by cotorphine synthase to form a dipeptide of cortorphine (L-tyrosine-L-arginine), which induces the met-enkephalin release and analgesic effect. Individual studies have demonstrated a decrease in the symptoms of urinary pain syndrome during L-arginine treatment, which made it possible to include it into the European Association of Urologists recommendations on the chronic pelvic pain treatment in 2017.
Clinical comparative study (2013) of the NO donator (L-arginine) effectiveness in the treatment of endometriosis-associated intermenstrual pelvic pain and dysmenorrhea showed a high efficiency of a 3-month course of combination therapy (dienogest 2 mg + Tivortin 4.2 g). Supplement of basic therapy by NO donator (L-аrginine) has shown a faster reaching the clinical effect on reducing endometriosis-associated symptoms and sustainable maintenance of the result achieved. The multifaceted pharmacological effects of L-arginine directly affect a number of essential factors for the adenomyosis development and progression, which allows using this drug in clinical practice.

Objective The aim of the present study is to determine the potential risk factors for adenomyosis and to investigate its relationship with accompanying gynecological pathologies and clinical characteristics. Materials and method This study is a retrospective analysis of 945 patients who underwent hysterectomy between

Adenomyosis of the uterus is characterized by the presence of islands of endometrial glands and stroma within the myometrium. Etiopathology of adenomyosis has not been clearly defined but it potentially interferes reproductive processes in cattle. The aim of this initial study was to evaluate the impact of age on the frequency of adenomyosis in cows. Endometrial tissues collected from cows slaughtered between Day 8 and 12 of the estrous cycle (N ¼ 72) were divided into two age groups: (1) 2 to 4 years old (N ¼ 36) and (2) 5 years old and older (N ¼ 36). The tissues were stained with hematoxylin and eosin. The adenomyosis histopathomorphologic stage was classified on a four-point scale according to the penetration of endometrial structures inside the perimetrium. The protein expression of the 17-b estradiol (E2) and progesterone (P4) receptors were evaluated in the endometrial tissue samples by immunohistochemistry and Western blot analysis, and E2 and P4 concentrations were measured in the peripheral blood and uterine tissue. Adenomyosis was observed in 38 of the cows examined including 13 of the 2-to 4-year-old cows and 25 of the cows 5 years old or older. The frequency and intensity of adenomyosis increased with age. Higher E2 receptor protein expression was observed in adenomyotic cows and increased with disease development and increase of number of glands inside the uterus in the direction of perimetrium, and P4 receptor protein expression were unchanged in healthy and adenomyotic cows. An increase in the expression of E2 receptors and high, supraphysiological levels of E2 was detected in cows with III and IV degree of adenomyosis (P < 0.05). Overexpression of E2 receptor and alternations in E2 secretion might make the bovine uterus susceptible to a growth advantage of adenomyotic tissue over the surrounding myometrium. The pathogenesis and immunoendocrine mechanisms controlling adenomyosis in cattle warrant further study. Published by Elsevier Inc.

A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for 1 year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis. Many questions this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.

A 46-year-old woman presented to the emergency department with abdominal pain and abnormal uterine bleeding over the last year. She had a history of failed cyclic progesterone with tranexamic acid over the last 3 months to control her bleeding attacks. She had a tender pelvi-abdominal mass of 28 weeks' gestation size. Therapeutic curettage was performed, followed by correction of her iron deficiency anemia with intravenous iron. The trans-abdominal ultrasound of the pelvi-abdominal mass showed asymmetrical myometrial thickening, predominantly its anterior wall, with myometrial hyperechoic regions surrounded by hypoechoic areas suggestive of adenomyosis uterus for magnetic resonance imaging (MRI) evaluation. The MRI evaluation confirmed the diagnosis of adenomyosis uterus and showed diffuse asymmetrical uterine adenomyosis, predominantly its anterior myometrial wall, with an ill-defined endo-myometrial junction. Total abdominal hysterectomy with bilateral salpingectomy and bilateral ovarian conservation was performed after departmental approval and the patient's consent. The routine pre-operative investigations were completely normal except the cancer antigen (CA-125) which was unexpectedly high (1658 and 1046 IU/ml repeated twice two days apart). The histological examination of the surgical removed uterus confirmed the diagnosis of adenomyosis uterus and the pre-operative high CA-125 decreased to 22 IU/ml (normal range 0-35 IU/ml) one week after surgery.

Progestin has been used for symptomatic treatment of adenomyosis, although its effect on the immune system has not been studied. The aim of this study was to investigate the changes of macrophage and natural killer (NK) In this randomized controlled clinical trial study, 24 patients with adenomyosis who re-12 patients were not treated with any hormones. The endometrial and myometrial tissue samples were immediately (CD57) was performed. to the untreated group (P=0.005) but not in stroma in the endometrium of the treated patients (P=0.416). The differ-metrial glands (P=0.055) or stromal tissues (P=0.506). Administration of oral progestin dienogest to patients with adenomyosis increased the number of uterine-plantation and fetal protection (Registration number: TCTR20150921001). Citation:-rophage and natural killer cells in adenomyosis: a randomized controlled study. Int J Fertil Steril. 2018; 11(4): 279-286.

study question: Is adenomyosis associated with IVF/ICSI outcome in terms of clinical pregnancy rate? summary answer: In a meta-analysis of published data, women with adenomyosis had a 28% reduction in the likelihood of clinical pregnancy at IVF/ICSI compared with women without adenomyosis.

Purpose To study the therapeutic effects of uterine artery embolization (UAE) on adenomyosis and to investigate the association between uterine blood supply and artery embolization treatment outcomes. Methods Using digital subtraction angiography (DSA) imaging data, we retrospectively evaluated the vascular features of 252 adenomyosis patients treated with UAE. The cases were classified based on the equality of uterine blood supply (equal and unequal subgroups) and the degree of vascularity at the adenomyosis lesion site (hypervascular, isovascular and hypo-vascular subgroups). Patients were followed-up for 5 years after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the relief of the patients' symptoms. The improvement rates among the different subgroups were analyzed and compared. Results The improvement rates of dysmenorrhea and menorrhagia were 74.0% and 70.9%, respectively , at the short-term (12-month) follow-up and 70.4% and 68.8%, respectively, at the long-term (5-year) follow-up. No statistically significant differences were observed in the improvement rates for dysmenorrhea or menorrhagia between the equal and unequal blood supply subgroups at either the short-or long-term follow-up. The improvement rates for dysmenorrhea among the hypervascular, isovascular and hypovascular subgroups were 86.5%, 71.8% and 58.8%, respectively, at the short-term follow-up (p = 0.002) and 83.6%, 67.3% and 52.8%, respectively, at the long-term follow-up (p = 0.005). The PLOS ONE |

Objectives: Sono-elastography is an imaging technique added to sonography, measuring tissue strain. The aim of this study is to systematically define specific sono-elastographic characteristics of the myometrium, fibroids and adenomyosis and evaluate the feasibility of sonoelastography in patients suspected of gynecological pathology and to compare it with histology-based and MRI-based diagnoses. Methods: We performed a prospective observational cohort study from 2009 to 2011 using a Samsung Medison Accuvix V10 machine. Women included underwent routine transvaginal ultrasound and additional real-time sonographic elastography. The acquirements of elastographic images were standardized. We analyzed elastographic characteristics of myometrium, fibroids and adenomyosis. An independent observer, unaware of clinical, histological or MRI findings evaluated the recorded elastographic images and cine loops. These elastographic-based diagnoses were compared with histology and/or MRI diagnosis. Results: With elastography the uterus is well delineated from the surrounding bowels. The myometrium was uniform in color in 49% of the cases, with a main color of purple or dark blue. Both fibroids and adenomyosis have different elastographic characteristics with different color patterns. In general fibroids were darker and adenomyosis brighter then adjacent myometrium. The agreement between elastography based diagnosis of fibroids and adenomyosis with MRI were excellent, and with histology it was also excellent for fibroids, but less optimal for adenomyosis. Conclusions: Elastography is able to identify clear discriminating characteristics of the uterus, fibroids and adenomyosis.

Introduction Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. Materials and methods Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38-129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. Results During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis.

Adenomyosis is related to infertility and miscarriages, but so far there are no robust in vitro models that reproduce its pathological features to study the molecular mechanisms involved in this disease. Endometrial organoids are in vitro 3D models that recapitulate the native microenvironment and reproduce tissue characteristics that would allow the study of adenomyosis pathogenesis and related infertility disorders. In our study, human endometrial biopsies from adenomyosis (n = 6) and healthy women (n = 6) were recruited. Organoids were established and hormonally differentiated to recapitulate midsecretory and gestational endometrial phases. Physiological and pathological characteristics were evaluated by immunohistochemistry, immunofluorescence, qRT-PCR, and ELISA. Secretory and gestational organoids recapitulated in vivo glandular epithelial phenotype (pan-cytokeratin, Muc-1, PAS, Laminin, and Ki67) and secretory and gestational features (α-tubulin, SOX9, SPP1, PAEP, LIF, and 17...

Background and Objective; Being considered a common benign uterine disorder, Adenomyosis (AD) is defined as the presence of an endometrial gland and stroma within the myometrium. It causes symptoms such as dysmenorrhea, menorrhagia, chronic pelvic pain, and infertility. It has a step-by-step treatment, initiating with medical therapy, conservative surgery, and finally, the hysterectomy. As some of the women with adenomyosis are nulligravid and want to become pregnant later, most patients prefer fertility-preserving surgery. Case Report: This study describes the management of diffuse posterior AD in a 36-year-old virgin female by triple flap technique and levonorgestrel intrauterine device (LNG-IUD) insertion during operation to prevent future recurrence and reduction of patient’s symptoms. The application of the triple flap technique and LNG-IUD in this patient was associated with excellent results. Conclusion: The wide excision of the lesion leads to symptom improvement, especially...

Adenomyosis is a common gynecologic disease. Pregnancy with adenomyosis is on the increase due to a tendency of delay with first pregnancies and various infertility treatments involved in the process. We encountered decidualized adenomyosis in three patients during pregnancy, who were suspected by magnetic resonance (MR) imaging and were followed monitored post delivery. The MR imaging findings of adenomyosis during pregnancy showed low signal intensity areas with embedded bright foci that expanded to a few mm in diameter on half Fourier single-shot turbo spin-echo images. This finding may reflect decidual change of the stroma within the ectopic endometrium caused during pregnancy. The MR imaging findings of adenomyosis after childbirth showed hemorrhage inside the lesion, which were assumed to be led by rapid decrease in a blood flow to adenomyosis post childbirth.

Author contributions SJO carried out experiments, analysed data and wrote the paper; JHS and HSL conceived experiments and analysed data; THK and JYY carried out experiments; BAL carried out experiments and analysed data; MMT and JPL provided transgenic mice; JYA, RRB, REL, ATF and JML conceived experiments and analysed data; and JWJ conceived experiments, analysed data and wrote the paper.

Endometriosis is a chronic disease that requires long-term treatment, the goal of which is effectively use drugs and avoids repeated surgical interventions.
The quality of patients’ life depends on the varying degrees of symptoms such as pelvic pain, dyspareunia, dysmenorrhea. Endometriosis causes infertility and perinatal complications. The symptoms of endometriosis often affect psychological and social well-being, and threaten the relationships, sexuality and mental health of women. Women with endometriosis have high levels of anxiety, depression, and other psychiatric disorders that can aggravate the severity of their pain.
The existing statistics on the endometriosis incidence is underestimated given the diagnostic difficulties. So far, there are no final, only generally an accepted method of treating endometriosis, and in most cases, treatment is only eliminates the symptoms. Today, it is desirable to take a conservative approach to treatment, avoiding surgery, and hormone therapy is recommended to relieve pain associated with endometriosis. An individual approach is important in the management of patients with endometriosis, taking into account the reproductive plans and needs of woman. Medical treatment methods should be used as much as possible, for example, dienogest 2 mg (in particular, Savis drug). Dienogest is a derivative of 19-nortestosterone, which has an antiproliferative effect on the endometriosis foci.
Savis is a drug specially formulated for the endometriosis treatment. Savis may be prescribed to relieve symptoms before and after surgery to prevent relapse. The safety profile of dienogest has been studied and data is constantly accumulating, given the popularity of its prescription.
The effectiveness of dienogest should be assessed primarily by its effect on pain and quality of life, on maintaining fertility, and on the possibility of avoiding or postponing surgery. This is important for various forms of endometriosis: endometriomas, extragenital endometriosis, adenomyosis.

Objective: To identify clinical characteristics associated with combined adenomyosis and fibroids and to determine whether preoperative diagnosis by ultrasonography correlates with postoperative diagnosis by pathology. Methods: A retrospective chart review was conducted of 206 women who attended Nassau University Medical Center, East Meadow, USA, between July 1, 2007, and June 30, 2010. The patients were stratified into 3 groups-fibroids only (n = 148); adenomyosis only (n = 21); or combined adenomyosis and fibroids (n = 37)-according to postoperative pathology findings and variables known to be associated with adenomyosis and fibroids. Significant variables were included in a multinomial regression analysis. Results: Dysmenorrhea was the only variable significantly associated with a diagnosis of adenomyosis. The odds ratio (OR) was 3.34 (95% confidence interval [CI], 1.14-9.80). Variables significantly associated with combined adenomyosis and fibroids were age (OR, 1.08; 95% CI, 1.01-1.15), black ethnicity (OR, 2.72; 95% CI, 1.11-6.68), and parity (OR, 1.44; 95% CI, 1.08-1.92). Preoperative diagnosis by ultrasonography did not correlate with the postoperative pathology report. Conclusion: Including the identified variables in the preoperative evaluation of patients with suspicion of fibroids might improve the counseling process and aid the choice of surgical procedure, especially among patients desiring a conservative approach.

To assess the association of adenomyotic foci with co-existing benign ovarian cysts.  This prospective cross-sectional study consisted of 100 consecutive hysterectomy specimens referred to Histopathology Section of Pathology Department, Peshawar Medical College, Peshawar, Pakistan by its attached teaching hospitals from January 2011 to December 2012. Hematoxylin and eosin stained sections were examined for adenomyotic foci and the presence of co-existent ovarian cysts. For evaluation of estrogen receptor (ER) status immunohistochemical stains were applied and H-scoring system was used with a score greater than 50 as positive.  Out of the 100 hysterectomy specimens, 25 cases had both adenomyosis and ovarian cysts. The ER status of adenomyotic foci was positive in 20% cases and negative in 80% cases. The commonest type of ovarian cyst was hemorrhagic luteal cyst (28%), followed by serous and mucinous cystadenoma (20%) each. Out of the 28% cases of functional cysts, 71.5% were ER posit...

Introduction and hypothesis Adenomyosis causes problems in women, including dysmenorrhea and abnormally heavy and prolonged menstrual bleeding; however, its etiology is unknown. We hypothesized that urinary symptoms are frequent in patients with adenomyosis and that they affect the patients' quality of life. Methods We conducted a pilot study from September 2011 to December 2011. Ninety-one patients with an ultrasound diagnosis of uterine adenomyosis comprised the study group (adenomyosis group). Ninety-four women with a normalappearing uterine myometrium on ultrasound comprised the control group. Patients filled out two validated questionnaires, the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Patients also underwent a pelvic examination and urinary symptoms were recorded. Groups were compared using the nonparametric Mann-Whitney U test, chi-square test, and Fisher's exact test. Results The frequency of urinary symptoms was significantly higher in the adenomyosis group than in the control group (P0 0.0001), including stress urinary incontinence, urgency, daytime frequency, urge urinary incontinence, and dyspareunia. Total UDI scores were significantly higher in the adenomyosis group than those in the control group (P<0.0001), as were IIQ scores of questions regarding social relations (P<0.05). Conclusions Our results suggest that urinary tract dysfunction is associated with adenomyosis and that urinary symptoms may affect patients' quality of life.

Objectives: To assess the impact of pelvic magnetic resonance imaging (MRI) findings in the indication for uterine-artery embolization in women with fibroids, as well as the correlation between MRI and ultrasound (US) examinations for diagnosing adenomyosis. Material and methods: A retrospective observational study was performed through the analysis of the medical records of 263 women referred for uterine-artery embolization as treatment for fibroids after undergoing US and MRI examinations. To compare uterine volume and fibroid measurement in US and MRI, the Wilcoxon test was used; for the number of fibroids, the McNemar test was used. The kappa coefficient was used to evaluate the correlation between US and MRI findings for diagnosing adenomyosis. Results: The mean age of patients was 37.9 ± 6.8 years and 191 (72.6%) were nulliparous. Forty-three patients with adenomyosis associated with fibroid were diagnosed by MRI; US indicated the presence of adenomyosis in 12 (4.56%) women. There was agreement between MRI and US in the diagnosis of adenomyosis in 218/263 (82.9%) patients (p < 0.05). In the US examination, the mean uterine volume was lower (389 ± 340.8 cm³) than that observed in MRI (472.2 ± 415.9 cm³; p < 0.001). Regarding the number of fibroids, MRI showed a greater number of patients with multiple fibroids (68.8% vs. 57.4%, MRI and US, respectively; p < 0.001). Conclusions: In women with fibroids referred for uterine-artery embolization, MRI findings led to the revision of the initial diagnosis in 17.1% cases. US showed a lower sensitivity for diagnosing adenomyosis than MRI.

The uterine junctional zone (JZ) alterations are correlated with adenomyosis. An accurate evaluation of the JZ may be obtained by 3-dimensional transvaginal sonography (TVS). The aim of the present prospective study was to assess the value of detectable alterations by 3-dimensional TVS of the JZ in patients with pelvic endometriosis (diagnosed by laparoscopy and histologic condition) and to compare these findings with those of women without pelvic endometriosis. STUDY DESIGN: Eighty-two patients who were scheduled for laparoscopy had undergone previous surgery and 2-and 3-dimensional TVS. Uterine multiplanar sections that were obtained by 3-dimensional TVS were used to evaluate JZ features. During laparoscopy, an accurate staging of pelvic endometriosis was performed. JZ thickness and JZ alterations were correlated with stage of endometriosis. RESULTS: Of the 82 patients, 59 patients had endometriosis at laparoscopy and histology. The maximum thickness of JZ in patients with endometriosis was significantly greater than in patients without endometriosis (6.5 AE 1.9 mm vs 4.8 AE 1.0 mm; P < .001). The features of JZ appeared similar at different stages, whereas they are statistically different if correlated with patients without endometriosis. CONCLUSION: JZ thickness and its alterations are different in patients with endometriosis compared with those women without endometriosis and are not correlated with American Society of Reproductive Medicine staging methods. Because these JZ ultrasound features are associated mostly with adenomyosis, a correlation between endometriosis and JZ hyperplasia and adenomyosis could be hypothesized. Noninvasive evaluation of the JZ may be useful in the identification of those women who are affected by endometriosis also in early stage of the disease when there are no other sonographic signs of pelvic endometriosis.

To evaluate the occurrence and intensity of cyclic pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy and to explore the effect of the procedure on pelvic pain relief in women with perioperative detection of endometriosis and in women with histologic confirmation of adenomyosis. Design: Prospective observational study with 12-month follow-up after laparoscopic supracervical hysterectomy (Canadian Task Force classification II-2). Setting: University teaching hospital in Norway. Patients: One hundred thirteen premenopausal women with preoperative cyclic pelvic pain treated via laparoscopic supracervical hysterectomy. Interventions: Study participants underwent laparoscopic supracervical hysterectomy and were followed up at the outpatient clinic at 12 months after the procedure. Measurements and Main Results: The main outcomes were occurrence, intensity, and reduction of cyclic pelvic pain and patient satisfaction measured using an ordinal and a visual analog scale at 12 months after the procedure. Of the 113 women included in the study, 8 were lost to follow-up. Consequently, 105 women (92.9%) were followed up at 12 months after surgery. All women had cyclic pelvic pain preoperatively, but only 34 (32.4%) experienced this pain at 12 months after the procedure. The intensity of pelvic pain was reduced from a mean (SD) of 5.5 (2.4) preoperatively to 0.7 (1.5) at 12 months after the procedure on a visual analog scale of 0 to 10 (p , .01). Endometriosis was diagnosed perioperatively in 14 women (12.4 %), and adenomyosis was confirmed at histologic analysis in 19 (18.1%). In women with perioperative detection of endometriosis or histologic confirmation of adenomyosis, there were no significant differences in main outcomes at 12 months after laparoscopic supracervical hysterectomy when compared with women without these diagnoses. Conclusion: Laparoscopic supracervical hysterectomy is associated with high patient satisfaction and reduces cyclic pelvic pain to a minimum by 12 months after the procedure.

Study objective: to optimize diagnostic measures in patients with adenomyosis and/or hyperplastic endometrial processes (HEP).
Material and methods. The study included 128 patients aged from 27 to 53 years. The first group included 38 (29.6%) patients with a grade I–II adenomyosis, the second group included 41 (32.1%) patients with a combination of grade I–II adenomyosis and HEP and/or uterine leiomyoma, the third group included 39 (30.5%) women with only HEP, the fourth (control) group included 10 (7,8%) women without endometrial pathology. Patients underwent hysteroscopy with targeted biopsy, elucidated the pathomorphological features of connective tissue component of the endometrium and uterus transitional zone, studied specific markers of adenomyosis progression, namely vascular endothelial growth factor and Ki-67 proliferation index, and also determined the parameters of shear wave ultrasound elastography.
Results. Routine histological examination of adenomyosis was confirmed only in 11 (30.6%) cases out of 36 suspected, while HEP (polyps, glandular hyperplasia) and hyperplastic pathology of endocervix (polyps) – in 34 (97.1%) cases out of 35 suspected. Ki-67 antigen expression was positive in the nuclei of epithelial cells in the adenomyosis glands and in the cytogenic stroma cells. A greater value of expression was in the epithelium of glands in superficially located heterotopies – with grade I–II adenomyosis compared with other studied groups. Shear wave elastography showed significant differences in the myometrium color between the first, third and control groups. The unchanged myometrium in all patients of the control group was characterized by staining in shades of blue, while in 9 (90%) patients the color was uniform.
Conclusion. It is recommended to use a shear wave ultrasound elastography in laboratory and instrumental examination with determination of Ki-67 proliferation protein expression and intensification of the neovascularization process in endometrial biopsy specimens to improve the diagnosis of adenomyosis.

The article describes the clinical case of the nodular form of adenomyosis, first detected in a patient at the age of 16 years after another appeal to a gynecologist in connection with pronounced prolonged dysmenorrhea with ultrasound of a small pelvis. After the diagnosis of “Nodular form of adenomyosis”, the patient received 6 injections of triptorelin acetate 3.62 mg, resulting in an adenomyosis node decreased in size from 72 x 68 mm to 31 x 29 mm. Taking into account the developed side effects (aches in bones, hot flushes, weakness, tachycardia), therapy with triptorelin was discontinued. Clinical efficacy persisted for 6 months, after which painful menstruation resumed.

Two years later, the patient was urgently transferred to the gynecological department of the Kyiv City Clinical Hospital No. 9 with severe manifestations of dysmenorrhea. With ultrasound of the pelvic organs, an endometrioid node in the uterus measuring 50 x 46 mm was found. The patient was recommended receiving Visanne (dienogest) in a dose of 2 mg, which she took 1 year and 10 months, being under constant supervision of the clinic’s specialists. The unauthorized break in treatment, which the patient explained with good health, provoked the resumption of painful symptoms. Visanne was continued for 2 years, as a result of which the endometrioid node decreased to 21.0 x 16.7 mm.

In April 2017, in connection with the patient’s marriage and the desire to become pregnant, the reception of the dienogest was canceled. It is proposed to take a plant complex of antiproliferative action containing indole-3-carbinol 200 mg and green tea extract 82 mg. After 8 months, the patient was diagnosed with a pregnancy at 4 weeks, against which the adenomyosis node decreased to 18.1 x 11.1 mm. The results of the first two ultrasound screenings of the fetus in the gestation period of 13 and 18 weeks are described. There were no deviations in fetal development, and the endometriosis focus in the uterus was not clearly visualized at the first screening.

The importance of the problem of secondary dysmenorrhea on the background of endometriosis, the establishment of a timely diagnosis and the choice of the right treatment tactics on which the future reproductive health of a teenage girl directly depends.

Background and Objective; Being considered a common benign uterine disorder, Adenomyosis (AD) is defined as the presence of an endometrial gland and stroma within the myometrium. It causes symptoms such as dysmenorrhea, menorrhagia, chronic pelvic pain, and infertility. It has a step-by-step treatment, initiating with medical therapy, conservative surgery, and finally, the hysterectomy. As some of the women with adenomyosis are nulligravid and want to become pregnant later, most patients prefer fertility-preserving surgery.
Case Report: This study describes the management of diffuse posterior AD in a 36-year-old virgin female by triple flap technique and levonorgestrel intrauterine device (LNG-IUD) insertion during operation to prevent future recurrence and reduction of patient’s symptoms. The application of the triple flap technique and LNG-IUD in this patient was associated with excellent results.
Conclusion: The wide excision of the lesion leads to symptom improvement, especially hypermenorrhea and dysmenorrhea; besides, the reconstruction of the uterine wall with this technique increases the risk of the possibility of future pregnancy for our patient.

Background and aim: Development of contrast specific ultrasound techniques and introduction of the second-generation ultrasound contrast agents have improved the ability of this technique in detecting and characterizing focal liver lesions (FLLs). The purpose of this study was to present the experience of four Romanian centers in the evaluation of FLLs by contrast enhanced ultrasound (CEUS), in daily practice. Materials and methods: We performed a multicentre retrospective study, including 1,244 FLLs, evaluated by means of CEUS in four Romanian centers with extensive experience in ultrasound, dur-