Sonographic findings in symptomatic patient with adenomyosis uteri

Document Type : Original Article

Authors

Obstetrics and Gynecology department, Faculty of Medicine, Beni-suef University, Egypt

Abstract

Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood, the different type and extension of adenomyosis detected by transvaginal ultrasound could be associated with clinical symptoms.  The current study was designed with an aim to correlate between ultrasound finding in symptomatic patient with adenomyosis and severity of the disease. It was a cross sectional study conducted on 100 symptomatic women with sonographic criteria of adenomyosis recruited from the outpatient gynecology and obstetrics clinic after proper counseling, history taking and ultrasound examination to detect ultrasound criteria of adenomyosis and doppler on uterine artery done to all patients to detect uterine artery resistance index, pulsatillity index and Vmax. There is a relation between Tumor vascular pattern and abnormal uterine bleeding mainly and chronic pelvic pain. We found non-statistically significant differences between sonographic findings and symptoms among the studied population

Keywords

Main Subjects


  1. Ishidera Y, Yoshida H, Oi Y, Katayama K, Miyagi E, Hayashi H, Shigeta H. Analysis of uterine corporeal mesenchymal tumors occurring after menopause. BMC Womens Health. 2019 Jan 18;19(1):13. doi: 10.1186/s12905-019-0714-5. PMID: 30658711; PMCID: PMC6339291.
  2. Van den Bosch T, de Bruijn AM, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, Bourne T, Timmerman D, Huirne JAF. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2019 May;53(5):576-582. doi: 10.1002/uog.19096. PMID: 29790217.
  3. Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertil Steril. 2009 Jan;91(1):201-6. doi: 10.1016/j.fertnstert.2007.11.025. Epub 2008 Feb 20. PMID: 18243177; PMCID: PMC2680233.
  4. Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, Zupi E. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril. 2014 Jul;102(1):143-150.e2. doi: 10.1016/j.fertnstert.2014.03.043. Epub 2014 Apr 29. PMID: 24794315.
  5. Lazzeri L, Morosetti G, Centini G, Monti G, Zupi E, Piccione E, Exacoustos C. A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. Fertil Steril. 2018 Nov;110(6):1154-1161.e3. doi: 10.1016/j.fertnstert.2018.06.031. PMID: 30396560.
  6. Reinhold C, Atri M, Mehio A, Zakarian R, Aldis AE, Bret PM. Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology. 1995 Dec;197(3):609-14. doi: 10.1148/radiology.197.3.7480727. PMID: 7480727.
  7. Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:16-24. doi: 10.1016/j.bpobgyn.2018.01.013. Epub 2018 Feb 14. PMID: 29506961.
  8. Exacoustos C, Lazzeri L, Martire FG, Russo C, Martone S, Centini G, Piccione E, Zupi E. Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease. J Minim Invasive Gynecol. 2022 Feb;29(2):291-299.e1. doi: 10.1016/j.jmig.2021.08.023. Epub 2021 Aug 28. PMID: 34464760.
  9. Lazzeri L, Morosetti G, Centini G, Monti G, Zupi E, Piccione E, Exacoustos C. A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. Fertil Steril. 2018 Nov;110(6):1154-1161.e3. doi: 10.1016/j.fertnstert.2018.06.031. PMID: 30396560.
  10. Higham JM, O'Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990 Aug;97(8):734-9. doi: 10.1111/j.1471-0528.1990.tb16249.x. PMID: 2400752.
  11. Abinader R, Warsof SL. Benefits and Pitfalls of Ultrasound in Obstetrics and Gynecology. Obstet Gynecol Clin North Am. 2019 Jun;46(2):367-378. doi: 10.1016/j.ogc.2019.01.011. PMID: 31056137.
  12. Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, Gordts S, Guo SW, Just PA, Noël JC, Pistofidis G, Van den Bosch T, Petraglia F. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020 Apr 15;26(3):392-411. doi: 10.1093/humupd/dmz049. PMID: 32097456.
  13. Li JJ, Chung JPW, Wang S, Li TC, Duan H. The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility. Biomed Res Int. 2018 Mar 15;2018:6832685. doi: 10.1155/2018/6832685. PMID: 29736395; PMCID: PMC5875064.