Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition

Struble, Jennifer; Reid, S.; Bedaiwy, Mohamed A.

doi:10.1016/j.jmig.2015.09.018

Cited by 248 publications

(252 citation statements)

References 97 publications

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“…It is characterized by the presence of ectopic endometrial glands and stroma within the myometrium, resulting in uterine enlargement. It can be asymptomatic, but can give rise to significant symptoms, most commonly menorrhagia and dysmenorrhea [1]. The treatment for adenomyosis can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

Cheung

2017

Ultrasonography

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While high-intensity focused ultrasound has been used for some time in the management of uterine fibroids, its effectiveness and safety in managing adenomyosis is less well established. A literature review was performed of all eligible reports using this modality as a treatment for adenomyosis. Relevant publications were obtained from the PubMed electronic database from inception through March 2016. Eleven articles, including information from 1,150 treatments and follow-up data from 990 patients, were reviewed. High-intensity focused ultrasound appears to be effective and safe in the management of symptomatic adenomyosis, and can be considered as an alternative uterine-sparing option for women with this condition.

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Section: Introductionmentioning

confidence: 99%

Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

Cheung

2017

Ultrasonography

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“…The etiology and molecular mechanisms of AM remain unclear (2). AM usually occurs in mothers >40 years old, with an incidence of 15-70% among this population sub-group (3). The primary clinical manifestations of patients are excessive menstrual bleeding, menstrual extension, dysmenorrhea, dyspareunia and chronic pelvic pain.…”

Section: Introductionmentioning

confidence: 99%

MicroRNA-17 downregulates expression of the PTEN gene to promote the occurrence and development of adenomyosis

2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the current study was to evaluate the expression of microRNA (miR)-17 in the endometrial tissues of patients with adenomyosis (AM) and determine its biological function in the occurrence and development of the disease. A total of 45 fresh endometrial tissues of AM patients and 32 normal endometrial tissues were collected from healthy controls. The expression of miR-17 was evaluated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The miR-17-targeting gene phosphatase and tensin homolog (PTEN) was predicted using bioinformatics and its expression was evaluated with RT-qPCR and western blot analysis. Endometrial cells were isolated from patients with AM and healthy controls. They were cultured in vitro and transfected with antagomiR-17 to downregulate miR-17 expression, subsequently cell viability and apoptosis were measured using MTT and flow cytometry. The expression of PTEN and cell cycle-and apoptosis-related proteins were evaluated using western blot analysis. Endometrial cells that stably overexpressed PTEN were screened in vitro by co-culture with G418. A dual-luciferase reporter assay was conducted to verify whether miR-17 was directly bound to PTEN mRNA. The results demonstrated that expression of miR-17 was significantly increased in the endometrial tissues of patients with AM compared with control patients (P<0.05). PTEN mRNA and protein expression were significantly lower in the AM group compared with the control group (P<0.05). When the expression of miR-17 in the cells was downregulated, the expression of PTEN was significantly increased (P<0.05). In addition, expression of Bcl-2 protein was significantly decreased and that of Bax protein significantly increased compared with the negative control (both P<0.05). The expression of cyclins E1 and D1 were also significantly downregulated (P<0.05). When PTEN was overexpressed or miR-17 was downregulated, the viability of endometrial cells significantly decreased and cell apoptosis significantly increased (all P<0.05). A dual-luciferase reporter assay indicated that miR-17 could directly bind to the PTEN mRNA 3'-untranslated region to regulate its expression. Thus the current study indicates that expression of miR-17 was increased in the endometrial tissues of patients with AM and may influence cell apoptosis and cyclin expression through the targeted regulation of PTEN. These results suggest that miR-17 promotes the occurrence and development of AM.

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“…In symptomatic cases, bleeding was present in 84% women aged > 35 years. Bleeding is the main symptom, present in approximately 40-60% women [16].…”

Section: Discussionmentioning

confidence: 99%

Impact of pelvic magnetic resonance imaging findings in the indication of uterine artery embolization in the treatment of myoma

et al. 2017

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Objectives: To assess the impact of pelvic magnetic resonance imaging (MRI) findings in the indication for uterine-artery embolization in women with fibroids, as well as the correlation between MRI and ultrasound (US) examinations for diagnosing adenomyosis. Material and methods:A retrospective observational study was performed through the analysis of the medical records of 263 women referred for uterine-artery embolization as treatment for fibroids after undergoing US and MRI examinations. To compare uterine volume and fibroid measurement in US and MRI, the Wilcoxon test was used; for the number of fibroids, the McNemar test was used. The kappa coefficient was used to evaluate the correlation between US and MRI findings for diagnosing adenomyosis. Results:The mean age of patients was 37.9 ± 6.8 years and 191 (72.6%) were nulliparous. Forty-three patients with adenomyosis associated with fibroid were diagnosed by MRI; US indicated the presence of adenomyosis in 12 (4.56%) women. There was agreement between MRI and US in the diagnosis of adenomyosis in 218/263 (82.9%) patients (p < 0.05). In the US examination, the mean uterine volume was lower (389 ± 340.8 cm³) than that observed in MRI (472.2 ± 415.9 cm³; p < 0.001). Regarding the number of fibroids, MRI showed a greater number of patients with multiple fibroids (68.8% vs. 57.4%, MRI and US, respectively; p < 0.001). Conclusions:In women with fibroids referred for uterine-artery embolization, MRI findings led to the revision of the initial diagnosis in 17.1% cases. US showed a lower sensitivity for diagnosing adenomyosis than MRI.

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Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition

Cited by 248 publications

References 97 publications

Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

MicroRNA-17 downregulates expression of the PTEN gene to promote the occurrence and development of adenomyosis

Impact of pelvic magnetic resonance imaging findings in the indication of uterine artery embolization in the treatment of myoma

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