Difference between revisions of "Uterine adenomyosis"

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

Latest revision as of 15:14, 6 June 2024

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

Common.
May be a cause of bleeding.^[1]
Dysmenorrhea - painful menses.^[2]
Associated with endometriosis.^{[citation needed]}

Gross

Features:

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

Note:

May form a mass - known as adenomyoma.^[5]

Image:

Microscopic

Features:

Endometrial glands within uterine muscle - key feature.
- Endometrial glands:
  - Circular.
  - Simple epithelial or pseudostratified epithelium +/- mitoses.
- +/-Surrounded by endometrial stroma.
  - Densely packed spindle cells without nuclear atypia.
- 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:

Endometrioid endometrial carcinoma.

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

Adenomyosis - low mag. (WC/Nephron)
Adenomyosis - intermed. mag. (WC/Nephron)
Adenomyosis - high mag. (WC/Nephron)
Adenomyosis - high mag. (WC/Nephron)
Adenomyosis - very high mag. (WC/Nephron)

Adenomyosis (WC/KGH)

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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.

References

↑ 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.
↑ 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.
↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 432. ISBN 978-0-323-06516-0.
↑ 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.
↑ 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.
↑ ^6.0 ^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.
↑ 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.
↑ Blaustein's pathology of the female genital tract, 1987, ISBN:0387964525.

[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.

[pmid22594861-2] 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.

[Ref_Lester3_432-3] Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 432. ISBN 978-0-323-06516-0.

[pmid20291238-4] 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.

[pmid16990713-5] 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.

[pmid27810281-6] 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.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

@@ Line 1: / Line 1: @@
-#redirect [[Uterus#Uterine_adenomyosis]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Uterine adenomyosis -- intermed mag.jpg
+| Width      =
+| Caption    = Uterine adenomyosis. [[H&E stain]].
+| Synonyms   =
+| Micro      = at least 2 of 3: (1) endometrial glands, (2) endometrial stroma, (3) hemosiderin-laden macrophages
+| Subtypes   =
+| LMDDx      = [[endometrioid endometrial carcinoma]]
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = globoid shape, slightly enlarged, trabeculated cut surface +/- small foci of hemorrhage
+| Grossing   =
+| Site       = [[uterus]]
+| Assdx      = [[endometriosis]] (?)
+| Syndromes  =
+| Clinicalhx =
+| Signs      = [[menorrhagia]]
+| Symptoms   = cyclic pelvic pain, dysmenorrhea
+| Prevalence = common
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    =
+| Tx         =
+}}
+'''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==
+*Common.
+*May be a cause of bleeding.<ref>{{Cite journal  | last1 = Reinhold | first1 = C. | last2 = Tafazoli | first2 = F. | last3 = Mehio | first3 = A. | last4 = Wang | first4 = L. | last5 = Atri | first5 = M. | last6 = Siegelman | first6 = ES. | last7 = Rohoman | first7 = L. | title = Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. | journal = Radiographics | volume = 19 Spec No | issue =  | pages = S147-60 | month = Oct | year = 1999 | doi =  | PMID = 10517451 | URL = http://radiographics.rsna.org/content/19/suppl_1/S147.full }}</ref>
+*Dysmenorrhea - painful menses.<ref name=pmid22594861>{{Cite journal  | last1 = Cockerham | first1 = AZ. | title = Adenomyosis: a challenge in clinical gynecology. | journal = J Midwifery Womens Health | volume = 57 | issue = 3 | pages = 212-20 | month =  | year =  | doi = 10.1111/j.1542-2011.2011.00117.x | PMID = 22594861 }}</ref>
+*Associated with [[endometriosis]].{{fact}}
+==Gross==
+Features:
+*Trabeculated cut surface +/- small foci of hemorrhage.<ref name=Ref_Lester3_432>{{Ref Lester3|432}}</ref>
+**Often described as "basket-weave" pattern.
+*Globoid, slightly enlarged.<ref name=pmid20291238>{{Cite journal  | last1 = HUNTER | first1 = WC. | last2 = SMITH | first2 = LL. | last3 = REINER | first3 = WC. | title = Uterine adenomyosis; incidence, symptoms, and pathology in 1,856 hysterectomies. | journal = Am J Obstet Gynecol | volume = 53 | issue = 4 | pages = 663-8 | month = Apr | year = 1947 | doi =  | PMID = 20291238 | URL = http://journals.lww.com/obgynsurvey/Citation/1947/10000/The_Uterus__Uterine_Adenomyosis__Incidence,.61.aspx }}</ref>
+Note:
+*May form a mass - known as ''[[adenomyoma]]''.<ref name=pmid16990713>{{Cite journal  | last1 = Tahlan | first1 = A. | last2 = Nanda | first2 = A. | last3 = Mohan | first3 = H. | title = Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature. | journal = Int J Gynecol Pathol | volume = 25 | issue = 4 | pages = 361-5 | month = Oct | year = 2006 | doi = 10.1097/01.pgp.0000209570.08716.b3 | PMID = 16990713 }}
+</ref>
+Image:
+*[http://www.flickr.com/photos/34342634@N02/5036818444/ Uterine adenomyosis (flickr.com/infopathic)].
+*[http://www.flickr.com/photos/34342634@N02/5036818516/ Uterine adenomyosis - close-up (flickr.com/infopathic)].
+==Microscopic==
+Features:
+*Endometrial glands within uterine muscle - '''key feature'''.
+**Endometrial glands:
+***Circular.
+***Simple epithelial or pseudostratified epithelium +/- mitoses.
+**+/-Surrounded by endometrial stroma.
+***Densely packed spindle cells without [[nuclear atypia]].
+**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''.<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:
+*[[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===
+<gallery>
+Image: Uterine adenomyosis -- low mag.jpg | Adenomyosis - low mag. (WC/Nephron)
+Image: Uterine adenomyosis -- intermed mag.jpg | Adenomyosis - intermed. mag. (WC/Nephron)
+Image: Uterine adenomyosis -- high mag.jpg | Adenomyosis - high mag. (WC/Nephron)
+Image: Uterine adenomyosis - alt -- high mag.jpg | Adenomyosis - high mag. (WC/Nephron)
+Image: Uterine adenomyosis -- very high mag.jpg | Adenomyosis - very high mag. (WC/Nephron)
+</gallery>
+<gallery>
+Image: Uterine adenomyosis (1).JPG | Adenomyosis (WC/KGH)
+</gallery>
+==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>
+UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
+- UTERUS WITH ADENOMYOSIS.
+- UTERINE CERVIX WITHIN NORMAL LIMITS.
+- PROLIFERATIVE PHASE ENDOMETRIUM.
+</pre>
+<pre>
+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.
+</pre>
+==See also==
+*[[Uterus]].
+*[[Adenomyosis]].
+==References==
+{{Reflist|2}}
+[[Category:Uterus]]
 [[Category:Diagnosis]]