Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity

Marcellin, Louis; Santulli, Piétro; Maignien, Chloé; Campin, L.; Lafay-Pillet, Marie-Christine; Millischer, Anne-Élodie; Bordonné, Corinne; Borghese, Bruno; Dousset, B.; Chapron, Charles

doi:10.1016/j.fertnstert.2020.05.003

Cited by 37 publications

(20 citation statements)

References 68 publications

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“…Furthermore. the B1 phenotype appears to correspond to the focal adenomyosis of the outer myometrium (FAOM) reported by Marcellin et al [24]. The prevalence of FAOM was 56.5% in 255 women with DIE.…”

Section: Plos Onesupporting

confidence: 54%

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

2021

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Background The aim of this study is to investigate the clinicopathological features of intrinsic and extrinsic subtypes in adenomyosis. In particular, we focused on the early lesions of adenomyosis. Methods This is a single-center, prospective study of women who elected surgery for adenomyosis at the Department of Gynecology, Nara Medical University Hospital, Kashihara, Japan, from April 2008 to March 2018. Adenomyosis was histologically classified as intrinsic, extrinsic, and others, depending on the type of intramural growth. Adenomyosis that occurs at the inner and outer myometrium was defined as an intrinsic and extrinsic type, respectively. Results One hundred eighty-nine patients with histologically confirmed adenomyosis were classified into three different types, 74 intrinsic type, 78 extrinsic type, and 37 other type. Compared to the intrinsic type, the extrinsic type was more likely to have endometriosis, including ovarian endometrioma (OMA), superficial peritoneal endometriosis (SUP), or deep infiltrating endometriosis (DIE). To further identify the clinicopathological features of early-stage adenomyosis, we focused only on patients with intrinsic and extrinsic types of adenomyosis with less than one-third of muscular layer infiltration. Patients with early-stage intrinsic adenomyosis were more likely to experience induced abortions. Patients with early-stage extrinsic adenomyosis were more likely to have endometriosis. The coexistence of endometriosis and the lack of induced abortion were independent predictors of extrinsic adenomyosis. Multivariate logistic regression analysis identified coexistence of endometriosis as independent predictors of the early stage extrinsic adenomyosis. Conclusion The study suggests that there are at least two types of adenomyosis, where the intrinsic type is closely associated with a history of induced abortion, while the extrinsic type is strongly associated with endometriosis. Adenomyosis might be a gynecological disorder with complex pathogenesis implicating both traumatic and endometriotic factors.

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Section: Plos Onesupporting

confidence: 54%

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

2021

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“…Nevertheless, there was a significant increase in the frequency of FAOM in endometriosis-affected women compared to controls. The term ‘focal adenomyosis’ refers to adenomyotic foci located in the outer shell of the uterus that are separated from the JZ by healthy muscular tissue [ 56 , 57 ], but focal disease is not restricted to the outer myometrium and the term has also been applied to focal affections of the outer, middle and inner myometrium [ 58 , 59 ]. Larsen et al [ 60 ] compared the incidence of adenomyosis in 153 patients with suspected deep infiltrating endometriosis (DIE, also referred to as rectovaginal endometriosis) and a reference group of 129 women.…”

Section: Co-existing Pathologymentioning

confidence: 99%

“…Understanding the pathophysiology can also have other implications for classification. Adenomyosis may represent a spectrum of diseases with the unifying feature of ectopic endometrium and stroma within the myometrium [ 57 ].…”

Section: Classifying Adenomyosismentioning

confidence: 99%

Classifying Adenomyosis: Progress and Challenges

Habiba

Benagiano

2021

IJERPH

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Classically, the diagnosis of adenomyosis relied on histological examination of uteri following hysterectomy and classifications focused on the depth of endometrial invasion within the myometrium. There remain uncertainties around the cut-off point for the histological diagnosis. Imaging-based diagnosis enables recognition of the condition in women not undergoing surgery and facilitates the assessment of the extent of adenomyosis within the whole uterus, as well as of affections of the uterovesical pouch and of the pouch of Douglas. In this article, we explore the diagnostic uncertainties, the need to produce a classification of the condition and the challenges towards that goal. A distinction should be drawn between disease mapping and a classification that may link histological or image-based features with clinical characteristics, or with pathophysiology. An agreed system for reporting adenomyotic lesions may enable comparisons of research studies and thus contribute towards an informed classification. To this aim, we outline the features of the condition and explore the characteristics that are considered when producing a taxonomy. These include the latest proposal for subdivision of adenomyosis into an internal and an external variant. We also explore the uncertainties linked to classifying involvement of the uterovesical pouch, the pouch of Douglas and lesions in the outer myometrium. The limitations of currently available evidence suggest that agreement on a hypothesis to underpin a classification is unlikely at present. Therefore, current efforts will probably remain focused on disease mapping.

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“…As a result, women often self-refer to centers of expertise only when repeat surgery is eventually necessary. The identification of adenomyosis as a predictor of ureteral endometriosis could be explained by its observed strong association with deep infiltrating endometriosis (4).…”

mentioning

confidence: 99%

Preoperative prediction of ureteral endometriosis without dilatation: instructions for use

Vercellini

Berlanda

Parazzini

2021

Fertility and Sterility

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Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity

Cited by 37 publications

References 68 publications

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

Classifying Adenomyosis: Progress and Challenges

Preoperative prediction of ureteral endometriosis without dilatation: instructions for use

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