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Adenomyosis is a common benign gynecological condition, defined as an extension of endometrial tissue into the myometrium. Some studies suggest that adenomyosis could be a favorable prediction factor associated with survival outcomes in endometrial cancer. The aim of our systematic review was to investigate the current knowledge regarding adenomyos...
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Context 1
... is likely to present aggressive tumor features (non-endometrioid histology, deep myometrial invasion, and sometimes a sarcomatous component). Possible relationships between adenomyosis and endometrial cancer are presented in Figure 2. Mahida H et al., in multivariate and univariate analyses, demonstrated shorter diseasefree survival (DFS) in patients with EC-AIA. ...
Citations
... A study by Zhu et al. concluded that the postoperative drug (GnRH agonist with oral contraceptives) use may be beneficial to reduce the recurrence of adenomyosis, especially for adenomyosis with endometriosis [14]. Szubert et al. in the review of adenomyosis as a risk factor for myometrial or endometrial neoplasms concluded that adenomyosis may be a potential risk factor for myometrial or endometrial neoplasms [15]. ...
Introduction: We present three case reports of extrauterine adenomyoma (recto-vaginal/retro-cervical, broad ligament, abdominal). The common presenting symptoms in our patients were pelvic pain, dysmenorrhea, and deep dyspareunia. The cases were successfully treated with laparoscopic excision by a multidisciplinary team of doctors. One patient showed adenomyoma co-existing with endometriosis on histopathological examination of the tissue sample. Case Series: We present 3 cases of extra uterine adenomyomas in 3 different sites, each case representing a different theory of origin and all cases managed laparoscopically with successful outcome without any complications. First case represent the implantation theory following antecedent myomectomy. Second case represents origin of adenomyoma as direct extension from the uterus with background of severe diffuse adenomyosis. Third case represents origin from Müllerian remnants in the recto-vaginal septum with no adenomyosis or obliteration of the pouch Douglas. Conclusion: We propose the theory that adenomyoma which is a form of adenomyosis should be regarded as a form of deep endometriosis involving the uterus rather than a separate entity. We believe that multidisciplinary laparoscopic treatment is the way forward for accurate diagnosis and treatment of adenomyosis in patients requiring to preserve fertility. Future research needs to focus on studying endometriosis behavior and recurrence according to the tissue host to understand the disease and tailor the management according to patient symptoms.
... For larger adenomyomas, GnRH-a alone is not the best option [39][40][41][42]. GnRH-a combined with dienogest can reduce the blood supply to the patient's adenomyoma lesions by reducing the estrogen and blood supply to the adenomyoma lesions. ...
... Adenomyosis is more commonly associated with endometrioid carcinoma, but clear cell carcinoma is also observed [3,4]. Certain cell types are involved, such as epithelial and mullerian types, with sarcomas described as well [11,12]. ...
... Even if endometriosis, adenomyosis and cancers have common manifestations, the pathogenic mechanism of malignant transformation remains unknown. A better knowledge of pathogenesis aids in diagnostic and therapeutic management [11,12]. The histological description is important for standardising the description of cancers developed from adenomyosis and to differentiate them from those that appear simultaneously with adenomyosis without knowing the exact relationship between them [13,14]. ...
... The pathogenesis of a malignant transformation in adenomyosis appears to involve inflammation and elevated levels of IL1 and IL6 [4]. The underlying mechanisms may involve genetic mutations, epigenetic changes, and tumour suppressor gene alterations in adenomyosis [11]. IL-37 is also involved in adenomyosis. ...
Cancer arising from adenomyosis is very rare, with transformation occurring in only 1% of cases and in older individuals. Adenomyosis, endometriosis and cancers may share a common pathogenic mechanism that includes hormonal factors, genetic predisposition, growth factors, inflammation, immune system dysregulation, environmental factors and oxidative stress. Endometriosis and adenomyosis both exhibit malignant behaviour. The most common risk factor for malignant transformation is prolonged exposure to oestrogens. The golden standard for diagnosis is histopathology. Colman and Rosenthal emphasised the most important characteristics in adenomyosis-associated cancer. Kumar and Anderson emphasised the importance of demonstrating a transition between benign and malignant endometrial glands in cancer arising from adenomyosis. As it is very rare, it is difficult to standardize treatment. In this manuscript, we try to emphasize some aspects regarding the management strategy, as well as how heterogenous the studies from the literature are in terms of prognosis in both cancers that develop from adenomyosis or those that are only associated with adenomyosis. The pathogenic mechanisms of transformation remain unclear. As these types of cancer are so rare, there is no standardised treatment. A novel target in the diagnosis and treatment of gynaecological malignancies associated with adenomyosis is also being studied for the development of new therapeutic concepts.
... adenomyosis in the muscle layer from the endometrium (from inside to outside) (1). So, the earlier staging and better prognosis are more common in EACA than in EAAFA (17). ...
... Different from endometrium adenocarcinoma in stage IB, which invades into deep myometrium from the eutopic endometrium, EAAFA arises from the adenomyotic epithelium within deep myometrium without invasion to surrounding tissues. However, further accumulation of the cases and molecular investigation are needed (17). ...
Background
Endometrioid adenocarcinoma is usually diagnosed by endometrial curettage with a positive rate of 94%, while a hysteroscopic examination can increase the positive rate. Differently, endometrioid adenocarcinoma arising from adenomyosis (EAAFA) is always misdiagnosed, even after endometrial curettage or hysteroscopy. EAAFA is rarely reported.
Case description
We reported two cases of EAAFA with long-term follow-ups of 9–10 years. The two cases were misdiagnosed even if endometrial curettage or hysteroscopy was performed. One case complained of postmenopausal vaginal bleeding with elevated CA199, and she was diagnosed by fast-frozen pathology during hysterectomy, followed by bilateral salpingo-oophorectomy and pelvic lymphadenectomy. In another case, a premenopausal woman with acquired progressive dysmenorrhea was diagnosed as EAAFA by the histopathological result after a transvaginal hysterectomy and had to undergo reoperation. The FIGO stage was IB in both cases. Chemotherapy or radiotherapy was performed after the operation. Patients were followed up for 9–10 years, with no metastasis or recurrence being observed.
Conclusion
The diagnosis of EAAFA is always delayed because of tumor-free eutopic endometrium and negative results of the endometrial curettage or hysteroscopy examination. Fast-frozen pathology of the whole uterus helps diagnose EAAFA precisely and avoids reoperation. Adenocarcinoma foci of EAAFA usually involve the myometrium deeply. A better prognosis of EAAFA should be expected due to good differentiation and negative lymphovascular space invasion.
... Some studies have even claimed that these conditions are related, but they have not shown consistent results nor reached an accurate conclusion yet. [33,34] The association between adenomyosis and other diseases still requires extensive clinical and molecular investigation. However, in any situation, the presence of adenomyosis does not exclude the possibility of comorbid diseases, so if there are symptoms such as abnormal uterine bleeding, efforts should be made to initially exclude adenomyosis as the primary cause. ...
Beneficial and detrimental effect of surgical adenomyomectomy is still controversial in infertile women with severely diffuse adenomyosis. The primary objective of this study was to assess whether a novel method of fertility-preserving adenomyomectomy could improve pregnancy rates. The secondary objective was to evaluate whether it could improve dysmenorrhea and menorrhagia symptoms in infertile patients with severe adenomyosis. A prospective clinical trial was conducted between December 2007 and September 2016. Fifty women with infertility due to adenomyosis were enrolled in this study after clinical assessments by infertility experts. A novel method of fertility-preserving adenomyomectomy was performed on 45 of 50 patients. The procedure included T- or transverse H-incision of the uterine serosa followed by preparation of the serosal flap, excision of the adenomyotic tissue using argon laser under ultrasonographic monitoring, and a novel technique of suturing between the residual myometrium and serosal flap. After the adenomyomectomy, the changes in the amount of menstrual blood, relief of dysmenorrhea, pregnancy outcomes, clinical characteristics, and surgical features were recorded and analyzed. All patients obtained dysmenorrhea relief 6 months postoperatively (numeric rating scale [NRS]; 7.28 ± 2.30 vs 1.56 ± 1.30, P < .001). The amount of menstrual blood decreased significantly (140.44 ± 91.68 vs 66.33 ± 65.85 mL, P < .05). Of the 33 patients who attempted pregnancy postoperatively, 18 (54.5%) conceived either by natural means, in vitro fertilization and embryo transfer (IVF-ET), or thawing embryo transfer. Miscarriage occurred in 8 patients, while 10 (30.3%) had viable pregnancies. This novel method of adenomyomectomy resulted in improved pregnancy rates, as well as relief of dysmenorrhea and menorrhagia. This operation is effective in preserving fertility potential in infertile women with diffuse adenomyosis.
... The cause of the disease is unknown (1). It can lead to symptoms such as increased menstruation, prolonged menstruation, and progressive aggravated dysmenorrhea (2). A prior study by Di Donato and coauthors found that 21.8% of patients with endometriosis have adenomyosis. ...
Background
Adenomyosis is a common gynecological disease in women. A relevant literature search found that approximately 82% of patients with adenomyosis chose to undergo hysterectomy. However, women of childbearing age are more likely to undergo surgery to preserve the uterus. Because it is difficult to determine the extent of adenomyosis, it is almost impossible to resect adenomyotic tissue and retain the uterus at the same time.
Materials and methods
Following ethics approval and patient consent, tissue samples were resected and prepared to create frozen slices for analysis. One slice was subjected to H&E staining while the remaining slices were photographed with Coherent Anti-Stokes Raman Scattering (CARS), Second-Harmonic Generation (SHG) microscopy, and Raman spectroscopy. Comparative observations and analyses at the same positions were carried out to explore the diagnostic ability of CARS, SHG, and Raman spectroscopy for adenomyosis.
Results
In adenomyotic tissue, we found two characteristic peaks at 1,155 and 1,519 cm –1 in the Raman spectrum, which were significantly different from normal tissue. The substances shown in the CARS spectrum were represented by peaks of 1,519 cm –1 . SHG microscopy showed a distribution of collagen at the focus of the adenomyosis.
Conclusion
This study represents a novel analysis of Raman microscopy, CARS, and SHG in the analysis of adenomyotic lesions. We found the diffraction spectrum useful in determining the focal boundary and the diagnosis of adenomyosis in the tested samples.
... As a tertiary referral hospital, we observed a relatively high rate of cancer compared to other studies where the cancer rate ranged between 0.12 and 1.2% among patients undergoing hysterectomies for benign indications [15,22,[25][26][27]. Additionally, we found that adenomyosis accompanied 25% of our endometrial cancer cases, in line with the literature [28,29]. It has been suggested that endometrial cancer coexisting with adenomyosis has a low histologic tumor grade, low FIGO stage, and better prognosis [30,31]. ...
... It has been suggested that endometrial cancer coexisting with adenomyosis has a low histologic tumor grade, low FIGO stage, and better prognosis [30,31]. Although the exact mechanism cannot be explained, the neoplastic potential in adenomyotic patients may be due to common risk factors such as hyperestrogenism (high BMI, hormone treatment, etc.), genetic mutations, and inflammatory factors that stimulate angiogenesis and cell proliferation [28,30]. Therefore, we suggest that adenomyosis screening could be added as a new risk parameter to the guidelines. ...
Background/Objectives: An endometrial sampling is recommended for patients experiencing abnormal uterine bleeding above the age of 40 or 45. Valid risk prediction models are needed to accurately assess the risk of endometrial cancer and avoid an unnecessary endometrial biopsy in premenopausal women. We aimed to assess the necessity and usefulness of preoperative endometrial sampling by evaluating premenopausal women who underwent hysterectomy for abnormal uterine bleeding after preoperative endometrial sampling at our clinic. Methods: A retrospective analysis was conducted on 339 patients who underwent preoperative endometrial sampling and subsequently underwent hysterectomy due to abnormal uterine bleeding. Detailed gynecologic examinations, patient histories, and reports of endometrial sampling and hysterectomy were recorded. Cohen’s Kappa (κ) statistic was utilized to evaluate the concordance between histopathological results from an endometrial biopsy and hysterectomy. Results: The mean age of the cohort was 47 ± 4 years. Endometrial biopsies predominantly revealed benign findings, with 137 (40.4%) cases showing proliferative endometrium and 2 (0.6%) cases showing endometrial cancer. Following hysterectomy, final pathology indicated proliferative endometrium in 208 (61.4%) cases, with 7 (2.1%) cases showing endometrioid cancer. There was a statistically significant but low level of concordance between histopathological reports of endometrial biopsy and hysterectomy results (Kappa = 0.108; p < 0.001). Significant differences were observed only in the body mass index of patients based on hysterectomy results (p = 0.004). When demographic characteristics were compared with cancer incidence, smoking status and preoperative endometrial biopsy findings showed statistically significant differences (p = 0.042 and p = 0.010, respectively). Conclusions: The concordance between the pathological findings of a preoperative endometrial biopsy and hysterectomy is low. Body mass index is an important differentiating factor between benign histopathologic findings of endometrium and endometrial neoplasia. Moreover, adenomyosis was found to be associated with endometrial cancer cases. The current approach to premenopausal women with abnormal uterine bleeding, which includes a routine endometrial biopsy, warrants re-evaluation by international societies and experts.
Adenomyosis refers to the presence of endometrial stroma and glands within the myometrium, whereas the ectopic location of endometrium outside the uterus identifies the condition of endometriosis. Both benign and gynecological conditions originate from a menstruation-related dysfunction, and they are typically observed in reproductive age women. Common pathogenetic mechanisms, shared risk factor profile, and their frequent coexistence support their similarities, despite each disease has its own features. Dysmenorrhea, dyspareunia, pelvic pain, and infertility resulting from relative hyperestrogenism, progesterone resistance, and inflammation are frequently observed in both diseases. Conversely, abnormal uterine bleeding (AUB) and heavy menstrual bleeding (HMB) are mostly associated with adenomyosis, and resulting iron deficiency anemia is commonly reported. Endometriosis, instead, is a disease often accompanied by systemic comorbidities, along with a chronic pain syndrome. However, common pathogenetic mechanisms and factors support the use of similar hormonal treatment approaches.
To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N = 46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.
Background:
Adenomyosis is a benign uterine disease and affected patients present with symptoms such as menorrhagia, chronic pelvic pain, abnormal uterine bleeding, and infertility. However, the specific mechanisms by which adenomyosis occurs need to be further studied.
Objective:
Dataset of adenomyosis from our hospital and a public database were analyzed using bioinformatics. Corresponding differentially expressed genes (DEGs) and gene enrichment were detected to explore potential genetic adenomyosis targets.
Methods:
Clinical data on adenomyosis were accessed based on the pathological specimens of patients with adenomyosis obtained from the Shengjing Hospital. R software was used to screen for DEGs, and volcano and cluster maps were drawn. Adenomyosis datasets (GSE74373) were downloaded from the GEO database. GEO2R online tool was used to screen for DEGs between adenomyosis and normal controls. Genes with P < 0.01 and |logFC| >1 were selected as DEGs. DAVID software was used for functional and pathway enrichment analyses. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed on common DEGs to obtain descriptions of the genes. The online database STRING was used for interaction gene retrieval. Moreover, Cytoscape software was used to construct a protein-protein interaction (PPI) network map for common DEGs to visualize potential gene interactions and screen the hub genes.
Results:
A total of 845 DEGs were identified in the dataset obtained from Shengjing Hospital. A total of 175 genes were downregulated, and 670 genes were upregulated. In the GSE74373 database, 1679 genes were differentially expressed, 916 genes were downregulated, and 763 genes were upregulated. A total of 40 downregulated and 148 upregulated common DEGs showed potential gene interactions. The top ten upregulated hub genes were CDH1, EPCAM, CLDN7, ESRP1, RAB25, SPINT1, PKP3, TJP3, GRHL2, and CDKN2A.
Conclusion:
Genes involved in tight junction may be key in the development of adenomyosis and may provide a potential treatment strategy for adenomyosis.
