Difference between revisions of "Uterine adenomyosis"

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Note:
Note:
*Can be thought of as [[endometriosis]] of the myometrium.
*Can be thought of as [[endometriosis]] of the myometrium.
*A large number of extent criteria exist - see ''extent criteria''.<ref name=pmid27810281>{{cite journal |authors=Abbott JA |title=Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management |journal=Best Pract Res Clin Obstet Gynaecol |volume=40 |issue= |pages=68–81 |date=April 2017 |pmid=27810281 |doi=10.1016/j.bpobgyn.2016.09.006 |url=}}</ref>


DDx:
DDx:
*[[Endometrioid endometrial carcinoma]].
*[[Endometrioid endometrial carcinoma]].
===Extent criteria===
Consensus is lacking on diagnostic criteria. Focal superficial endometrial glands are generally not deemed sufficient by most.<ref name=pmid27810281>{{cite journal |authors=Abbott JA |title=Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management |journal=Best Pract Res Clin Obstet Gynaecol |volume=40 |issue= |pages=68–81 |date=April 2017 |pmid=27810281 |doi=10.1016/j.bpobgyn.2016.09.006 |url=}}</ref>
====Selected criteria====
{| class="wikitable sortable"
!Diagnostic criterium
!Category / Comment
!Reference
|-
| endometrial-myometrial interface disrupted
| anatomical definition
| <ref>{{cite journal |authors=Uduwela AS, Perera MA, Aiqing L, Fraser IS |title=Endometrial-myometrial interface: relationship to adenomyosis and changes in pregnancy |journal=Obstet Gynecol Surv |volume=55 |issue=6 |pages=390–400 |date=June 2000 |pmid=10841317 |doi=10.1097/00006254-200006000-00025 |url=}}</ref>
|-
| >2.5 mm myometrial invasion
| measurement criterium
| <ref>Blaustein's pathology of the female genital tract, 1987, ISBN:0387964525.</ref>
|-
|}
Abbott published a summary table of various criteria.<ref name=pmid27810281/>


===Images===
===Images===
<gallery>
<gallery>
Image: Uterine adenomyosis -- low mag.jpg | Adenomyosis - low mag.
Image: Uterine adenomyosis -- low mag.jpg | Adenomyosis - low mag. (WC/Nephron)
Image: Uterine adenomyosis -- intermed mag.jpg | Adenomyosis - intermed. mag.
Image: Uterine adenomyosis -- intermed mag.jpg | Adenomyosis - intermed. mag. (WC/Nephron)
Image: Uterine adenomyosis -- high mag.jpg | Adenomyosis - high mag.
Image: Uterine adenomyosis -- high mag.jpg | Adenomyosis - high mag. (WC/Nephron)
Image: Uterine adenomyosis - alt -- high mag.jpg | Adenomyosis - high mag.
Image: Uterine adenomyosis - alt -- high mag.jpg | Adenomyosis - high mag. (WC/Nephron)
Image: Uterine adenomyosis -- very high mag.jpg | Adenomyosis - very high mag.
Image: Uterine adenomyosis -- very high mag.jpg | Adenomyosis - very high mag. (WC/Nephron)
</gallery>
<gallery>
Image: Uterine adenomyosis (1).JPG | Adenomyosis (WC/KGH)
</gallery>
</gallery>


==Sign out==
==Sign out==
<pre>
Uterus, Bilateral Fallopian Tubes, Hysterectomy and Bilateral Salpingectomy:
- Uterine adenomyosis, extensive.
- Uterine leiomyoma.
- Proliferative endometrium.
- Fallopian tubes within normal limits.
- NEGATIVE for malignancy.
</pre>
===Block letters===
<pre>
<pre>
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:

Latest revision as of 15:14, 6 June 2024

Uterine adenomyosis
Diagnosis in short

Uterine adenomyosis. H&E stain.

LM at least 2 of 3: (1) endometrial glands, (2) endometrial stroma, (3) hemosiderin-laden macrophages
LM DDx endometrioid endometrial carcinoma
Gross globoid shape, slightly enlarged, trabeculated cut surface +/- small foci of hemorrhage
Site uterus

Associated Dx endometriosis (?)
Signs menorrhagia
Symptoms cyclic pelvic pain, dysmenorrhea
Prevalence common
Prognosis benign

Uterine adenomyosis, also adenomyosis of the uterus, is a relatively common benign pathology of the uterine corpus. It can be thought of as endometriosis in the uterine smooth muscle.

Uterine adenomyoma redirects here.

General

Gross

Features:

  • Trabeculated cut surface +/- small foci of hemorrhage.[3]
    • Often described as "basket-weave" pattern.
  • Globoid, slightly enlarged.[4]

Note:

Image:

Microscopic

Features:

  • Endometrial glands within uterine muscle - key feature.
    • Endometrial glands:
      • Circular.
      • Simple epithelial or pseudostratified epithelium +/- mitoses.
    • +/-Surrounded by endometrial stroma.
    • Blood:
      • Within glands.
      • Hemosiderin-laden macrophages.

Note:

  • Can be thought of as endometriosis of the myometrium.
  • A large number of extent criteria exist - see extent criteria.[6]

DDx:

Extent criteria

Consensus is lacking on diagnostic criteria. Focal superficial endometrial glands are generally not deemed sufficient by most.[6]

Selected criteria

Diagnostic criterium Category / Comment Reference
endometrial-myometrial interface disrupted anatomical definition [7]
>2.5 mm myometrial invasion measurement criterium [8]

Abbott published a summary table of various criteria.[6]

Images

Sign out

Uterus, Bilateral Fallopian Tubes, Hysterectomy and Bilateral Salpingectomy:
- Uterine adenomyosis, extensive.
- Uterine leiomyoma.
- Proliferative endometrium.
- Fallopian tubes within normal limits.
- NEGATIVE for malignancy.

Block letters

UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH ADENOMYOSIS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- PROLIFERATIVE PHASE ENDOMETRIUM.
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH SUPERFICIAL ADENOMYOSIS.
- UTERINE CERVIX WITH PARTIAL DENUDATION, FOCUS OF ENDOMETRIOSIS AND INFLAMMATION,
  OTHERWISE WITHIN NORMAL LIMITS.
- SUPERFICIAL FIBROSIS AND HYALINE CHANGE OF THE UTERINE LINING -- COMPATIBLE
  WITH PRIOR ABLATION.

See also

References

  1. Reinhold, C.; Tafazoli, F.; Mehio, A.; Wang, L.; Atri, M.; Siegelman, ES.; Rohoman, L. (Oct 1999). "Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.". Radiographics 19 Spec No: S147-60. PMID 10517451.
  2. Cockerham, AZ.. "Adenomyosis: a challenge in clinical gynecology.". J Midwifery Womens Health 57 (3): 212-20. doi:10.1111/j.1542-2011.2011.00117.x. PMID 22594861.
  3. Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 432. ISBN 978-0-323-06516-0.
  4. HUNTER, WC.; SMITH, LL.; REINER, WC. (Apr 1947). "Uterine adenomyosis; incidence, symptoms, and pathology in 1,856 hysterectomies.". Am J Obstet Gynecol 53 (4): 663-8. PMID 20291238.
  5. Tahlan, A.; Nanda, A.; Mohan, H. (Oct 2006). "Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature.". Int J Gynecol Pathol 25 (4): 361-5. doi:10.1097/01.pgp.0000209570.08716.b3. PMID 16990713.
  6. 6.0 6.1 6.2 Abbott JA (April 2017). "Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management". Best Pract Res Clin Obstet Gynaecol 40: 68–81. doi:10.1016/j.bpobgyn.2016.09.006. PMID 27810281.
  7. Uduwela AS, Perera MA, Aiqing L, Fraser IS (June 2000). "Endometrial-myometrial interface: relationship to adenomyosis and changes in pregnancy". Obstet Gynecol Surv 55 (6): 390–400. doi:10.1097/00006254-200006000-00025. PMID 10841317.
  8. Blaustein's pathology of the female genital tract, 1987, ISBN:0387964525.