Pathogenesis and malignant transformation of adenomyosis (Review)

Abstract

Abstract. The aim of our review was to identify the current information with regard to the pathogenesis and malignant transformation of adenomyosis. The current literature was reviewed by searching MEDLINE/PubMed, using the following keywords: adenomyosis, myometrium, stromal cells, malignant transformation, pathogenesis, etiology, genome-wide and microarray. Early signs of the development of adenomyosis are considered to be the penetration of stromal cells into the inner layer of the myometrium. Adenomyosis smooth muscle cells are developed, possibly, through a remodeling pathway via reactivation of coelomic epithelial cells as a result of estrogeninduced epithelial mesenchymal transition. Smooth muscle cell hyperplasia and hypertrophy are a reflection of a reaction of the surrounding tissue. The development of adenocarcinoma arising from adenomyosis is a relatively rare occurrence. In our literature review, to date, 44 cases of malignant tumors arising from adenomyosis have been documented. Studies reporting results of genetic abnormalities, epigenetic changes, monoclonal expansion, mutational analysis and the inactivation of specific tumor suppressor genes are very few in this field. In conclusion, adenomyosis can be a precursor of some carcinomas. The exact molecular mechanisms that lead to the malignant transformation are poorly understood.

Significance of Adenomyosis on Tumor Progression and Survival Outcome of Endometrial Cancer

“…47 Furthermore, our data do not have a control group for nonendometrial cancer in which to compare the incidence of adenomyosis. While it is speculated that a certain fraction of adenomyosis may be a precursor of endometrial cancer, 48 it remains understudied as to whether or not adenomyosis increases the risk of endometrial cancer, and the exact molecular mechanism of oncogenesis in adenomyosis remains unknown. Therefore, further studies are warranted to examine this link.…”

Uterine peristalsis-induced stresses within the uterine wall may sprout adenomyosis

“…In spite of being a common gynecological disorder, the etiology and pathogenesis of adenomyosis remains unclear. Several hypotheses were proposed to explain the origin of adenomyosis, ranging from histogenesis of embryonic cells to tissue remodeling due to physical trauma to the uterine wall (Koike et al 2013). Recently, increased evidence on uterine peristalsis led to the proposal of the 'tissue injury and repair' (TIAR) mechanism as the etiology for migration of endometrial cells into the myometrium (Leyeyndecker and Wildt 2011;Leyendecker et al 2004).…”

Endometrioid Adenocarcinoma Arising From Adenomyosis in a Premenopausal Woman: A Case Report

“…The etiology and pathogenesis of adenomyosis remain undecided. There have been 44 reported cases of adenocarcinoma developing within adenomyosis [11]. Most of the patients were postmenopausal.…”

“…In general, malignant transformation of adenomyosis is positive for ER, PR, cyclooxygenase-2 (COX-2), CA125 and focally weak-positive for aromatase. Hormonal receptor expression is associated with low-grade and early-stage tumors [11]. Kucera et al, having researched the clinical data of 219 patients with the diagnosis of early endometrial cancer, reported that adenomyosis was found in 88 of them and malignant changes in adenomyosis were present in six (6.8%) of those 88 patients.…”