ADENOMYOSIS AMONG SAMPLES FROM HYSTERECTOMY DUE TO ABNORMAL UTERINE BLEEDING
AbstractBackground: Adenomyosis is one of the most common, yet under diagnosed, underlying cause of abnormal uterine bleeding. We aimed to evaluate the presence of adenomyosis among the patients who presented with abnormal uterine bleeding. Methods: This was a retrospective study carried out on hysterectomy specimens of subjects who presented to the gynaecologist with the complaint of abnormal uterine bleeding not responding to conservative treatment. Excluded are the hysterectomies performed for malignant pelvic neoplasms and hysterectomy following labour for postpartum haemorrhage. Results: A total of 861 women underwent hysterectomy out of which 779 were abdominal and 82 vaginal from Jan 2008 to Dec 2012. Adenomyosis was found in 296 of the 861 specimens studied. The most frequent combination of diagnosis was leiomyoma and adenomyosis. Pathologic conditions associated with adenomyosis were: leiomyomas 150 (50.6%), endometrial polyp 16 (5.4%), genital prolapse 12 (4.05%), chronic endometritis 10 (3.3%), endometrial hyperplasia 5 (1.6%), endocervical polyps 2 (0.6%). Conclusion: Adenomyosis is a common pathologic finding significantly related to reproductive and menstrual characteristics of the patients.Keywords: Adenomyosis, Hysterectomy, Leiomyoma
Ferenczy A. Pathophysiology of Adenomyosis. Hum Reprod Update 1998;4(4):312–22.
Thompson JR, Davion RJ. Adenomyosis of uterus: An enigma. J Natl Med Ass 1978;4:305–7.
Katz VL, Lentz G, Lobo RA, Gershenson D. (Eds). Comprehensive gynecology. 5th ed. 2007, Philadelphia, Pa.: Mosby Elsevier; 2007.
Matalliotakis IM. Kourtis AI, Panidis DK. Adenomyosis. Obstet Gynecol Clin North Am 2003;30(1):63–82.
Leyendecker G, Kunz G, Kissler S, Wildt L. Adenomyosis and reproduction. Best Pract Res Clin Obstet Gynaecol 2006;20:523–46.
Kuligowska E, Deeds L 3rd, Lu K 3rd. Pelvic pain: overlooked and under diagnosed gynecologic conditions. Radiographics 2005;25:3–20.
Zaloudek C, Norris HJ. Mesenchymal tumors of the uterus. In: Kurman RJ (Ed). Blaustein’s Pathology of the Female Genital Tract. 3rd ed. New York, NY: Mosby 2004.
Popp LW, Schwiedessen JP, Gaetje R. Myometrial biopsy in the diagnosis of adenomyosis uteri. Am J Obstet Gynecol 1993;169:546–9.
Yamamoto T, Noguchi T, Tamura T, Kitawaki J, Okada H. Evidence of estrogen secretion in adenomyotic tissue. Am J Obstet Gynecol 1993;169:734–8.
Huang H, Yu H, Chan S, Lee C, Wang H, Soong Y. Eutopic endometrial interleukin-18 system mRNA and protein expression at the level of endometrial-myometrial interface in adenomyosis patients. Fertil Steril 2010;94(1):33–9.
Xiao Y, Sun X, Yang X, Zhang J, Xue Q, Cai B, et al. Leukemia inhibitory factor is dysregulated in the endometrium and uterine flushing fluid of patients with adenomyosis during implantation window. Fertil Steril 2010;94(1):85–9.
Amin A, Ali A, Amin Z, Sani FN. Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a teaching Hospital in Peshawar, Pakistan. Pak J Med Sci 2013;29(1):170–2.
Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2006;20(4):547–55.
Akhtar S, Asif S, Aoshan R. Adenomyosis: a study of 3030 cases. J Coll Physicians Surg Pak 1996;6:260–1.
Azziz R. Adenomyosis current Perspective. Obstet Gynecol Clin North Am 1989;16:221–6.
Young RH, Treger T, Scully RE. Atypical polypoid adenomyoma of the uterus: a report of 27 cases. Am J Clin Pathol 1986;86:139–45.
Merrill JA, Creasman WT. Disorders of the uterine corpus. In: Scott JR, Di Sala PJ, Hammond CB, (Eds). Danforth’s Obstetrics and Gynecology. 6th ed. Philadelphia: Lippincott; 1990. p.1023.
Shrestha A, Shrestha R, Sedhai LB, Pandit U. Adenomyosis at hysterectomy: prevalance, patient characteristics, clinical profile and histopathological findings. Kathmandu Univ Med J 2012;10(37):53–6.
Mahmood M, Wahed K. Analysis of abdominal hysterectomy performed for benign gynaecological conditions in a hospital (WAH) of Pakistan. Pak Armed Forces Med J 2010;60(4):578–81.
Nisa Q, Habibullah, Shaikh TA, Hemlata, Memon F, Memon Z. Hysterectomies an audit at a tertiary care hospital. Professional Med J 2011;18(1):46–50.
Sobande AA, Eskander M, Archibong EI, Damole IO. Elective hysterectomy: A clinicopathological review from Abha catchment area of Saudi Arabia. West Afr J Med 2005;24(1):31–5.
Shergill SK, Shergill HK, Gupta M, Kaur S. Clinicopathological study of hysterectomies. J Indian Med Assoc 2002;100(4):238–9.
Ahsan S, Naeem S, Ahsan A. A case note analysis of hysterectomies performed for non neoplastic indications Liaquat National Hospital, Karachi. J Pak Med Ass 2001;51:346–9.
Vavilis D, Agorastos T, Tzafetas J, Loufopoulos A, Vakiani M, Constantinidis T, et al. Adenomyosis at hysterectomy: prevalence and relationship to operative findings and reproductive and menstrual factors. Clin Exp Obstet Gynecol 1997;24(1):36–8
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