Difference between revisions of "Uterine adenomyosis"
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{{ 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 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. | ||
| Line 37: | Line 68: | ||
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=== | |||
<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== | ==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
- 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:
- Uterine adenomyosis (flickr.com/infopathic).
- 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.
- Endometrial glands:
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
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)
.JPG)
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
- ↑ 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.