Adenomyosis and Coexisting Gynaecological Pathologies

Abstract

Introduction: Adenomyosis is defined as presence of benign endometrial tissue comprising of both endometrial glands and stroma into the myometrium leading on to diffuse enlargement of the uterus. Adenomyosis co-exists with various pathologies such as leiomyomas, endometriosis, endometrial polyp, endometrial hyperplasia and carcinoma suggesting hyperestrogenism to be a factor in pathogenesis of adenomyosis. Aim: To study the associated pathological conditions and histopathological patterns of endometrium in patients presenting with Abnormal Uterine Bleeding (AUB) due to adenomyosis. Materials and Methods: This retrospective study was conducted in a tertiary care institute of Punjab for a period of two years (August 2018 to August 2020). All the patients who underwent hysterectomy were re-evaluated and cases diagnosed with adenomyosis were included in the study. Clinical details were recorded. A total of 101 patients were diagnosed with adenomyosis. These cases were reviewed for presenting symptoms and correlated with histological features of endometrium and other associated gynaecological pathologies. The quantitative variables were expressed as mean and qualitative variables as percentages. Results: The age of the patients who had adenomyosis ranged from 29 to 79 years, majority were in the age group of 41-50 years. AUB was the most common symptom. The histopathological examination revealed associated pattern of endometrium from proliferative endometrium to endometrial hyperplasia and endometrial carcinoma. Other gynaecological pathologies include leiomyoma, adenocarcinoma ovary, serous adenomas of ovary and Cervical Intraepithelial Neoplasia (CIN) grade 3. Co-existence with leiomyoma is most common. Hyperestrogenemia can be considered as a risk factor as it is associated with leiomyomas, endometrial hyperplasia, endometrial carcinoma or polyps. Conclusion: Adenomyosis is one of the causes of AUB and this decreases the quality of life in women. It is also considered as a cause of infertility. The associated histopathological findings vary from leiomyoma, endometrial hyperplasia, endometrial polyps and rarely adenocarcinoma of endometrium and ovary. Meticulous and careful examination of gross and microscopic foci of adenomyosis and associated pathologies can help in better management of patients.

Keywords

• abnormal uterine bleeding
• endometrial hyperplasia
• hyperestrogenemia
• hysterectomy
• leiomyoma