Adenomyosis: modern diagnostic possibilities
DOI: https://doi.org/10.29296/25877305-2022-08-05
Issue:
8
Year:
2022
Objective. To assess comprehensive examination results in patients with adenomyosis.
Subjects and methods. The investigation enrolled 59 reproductive-aged and premenopausal (40.5±6.2 years) patients with adenomyosis verified in 42 (71.2%) cases, with no concurrent uterine myoma, as well as 20 control group patients. The investigation used traditional methods, such as 3D ultrasound, magnetic resonance imaging, hysteroscopy and biopsy of the endometrium and myometrium, histological examination, and statistical methods.
Results. The patients with adenomyosis were found to include persons who were younger than 35 years (28.8%), nulliparous (25.4%), and infertile (19.1%); those who had undergone peritoneal endometriosis (11.9%) or uterine (28.8%) surgeries; and those who had predominant dysmenorrhea (96.6%). The uterine volume was higher in 83.1% of adenomyosis patients than that in the control group (103.35±13.01 and 42.4±2.96 cm3, respectively; p=0.000); the myometrial wall asymmetry with a difference in the anterior and posterior wall thickness was 7.01±1.8 mm in 47.6% of patients; and the myometrial junctional zone thickness was ≥12 mm in 62.5%. There was an increased uterine radial and basal artery resistance index and reduced myometrial vascularization indices in comparison with the control (p
Keywords:
gynecology
adenomyosis
myometrial junctional zone
myometrial biopsy
echography
Doppler sonography
magnetic resonance therapy
References:
- Ouchi N., Akira S., Mine K. et al. Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention. J Obstet Gynaecol Res. 2014; 40: 230–6. DOI: 10.1111/jog.12164
- Techatraisak K., Hestiantoro A., Ruey S. et al. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis (ENVISIOeN): interim results from a prospective cohort study under reallife clinical practice. BMC Women’s Health. 2019; 19 (1): 68. DOI: 10.1186/s12905-019-0758-6
- Gusev D.V., Prilutskaya V.Yu., Chernukha G.E. Relapses of endometrioid ovarian cysts and possible ways to reduce them. Gynecology. 2020; 22 (3): 34–8 (in Russ.). DOI: 10.26442/20795696.2020.3.200144
- Klinyshkova T.V., Perfilieva O.N., Gordienko N.G. et al. Influence of ovarian endometrioma size on the state of ovarian reserve in patients with infertility. Russian Bulletin of the Obstetrician-Gynecologist. 2015; 15 (1): 47–51(in Russ.). DOI: 10.17116/rosakush201515147-51
- Vercellini P., Parazzini F., Oldani S. et al. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Human Reprod. 1995; 10 (5): 1160–2. DOI: 10.1093/oxfordjournals.humrep.a136111
- Chapron C., Marcellin L., Borghese B. et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrin. 2019; 15: 666–82. DOI: 10.1038/s41574-019-0245-z
- Klinyshkova T.V., Perfilieva O.N., Frolova N.B. Ddifferentiated tactics of patients with endometriomas associated with infertility. Lechashchii vrach. 2015; 8: 71–5 (in Russ.).
- Vercellini P., Viganò P., Somigliana E. et al. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006; 20 (4): 465–77. DOI: 10.1016/j.bpobgyn.2006.01.017
- Templeman C., Marshall S.F., Ursin G. et al. Adenomyosis and endometriosis in the California Teachers Study. Fertil Steril. 2008; 90 (2): 415–24. DOI: 10.1016/j.fertnstert.2007.06.027
- Tosti C., Troia L., Vannuccini S. et al. Current and future medical treatment of adenomyosis. Journal of Endometriosis and Pelvic Pain Disorders. 2016; 8(4): 127–35. DOI: 10.5301/je.5000261
- Vannuccini S., Tosti C., Carmona F. et al. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017; 35 (5): 592–601. DOI: 10.1016/j.rbmo.2017.06.016
- Pinzauti S., Lazzeri L., Tosti C. et al. Transvaginal sonographic features of diffuse adenomyosis in 18–30-year-old nulligravid women without endometriosis: association with symptoms. Ultrasound Obstet Gynecol. 2015; 46 (6): 730–6. DOI: 10.1002/uog.14834
- Chapron C., Tosti C., Marcellin L. et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod. 2017; 32 (7): 1393–401. DOI: 10.1093/humrep/dex088
- Gordts S., Brosens J., Fusi L. et al. Uterine adenomyosis: a need for uniform terminology and classification. Reprod Bio Med Online. 2008; 17: 244–8. DOI: 10.1016/s1472-6483(10)60201-5
- Ozerskaya I.A. Echography in gynecology. Ed. 2nd. M.: VIDAR, 2013; 564 р. (in Russ.).
- Bazot M., Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018; 109 (3): 389–97. DOI: 10.1016/j.fertnstert.2018.01.024
- 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 (4): 471–9. DOI: 10.1002/uog.8900
- Dzhamalutdinova K.M., Kozachenko I.F., Gus A.I. et al. The pathogenesis and diagnosis of adenomyosis: current aspects. Obstetrics and Gynecology. 2018; 1: 29–34 (in Russ.). DOI: 10.18565/aig.2018.1.29-34