Role of benign ovarian cysts in the development of adenomyosis

Abstract

Objectives:To assess the association of adenomyotic foci with co-existing benign ovarian cysts.Methods:This prospective cross-sectional study consisted of 100 consecutive hysterectomy specimens referred to Histopathology Section of Pathology Department, Peshawar Medical College, Peshawar, Pakistan by its attached teaching hospitals from January 2011 to December 2012. Hematoxylin and eosin stained sections were examined for adenomyotic foci and the presence of co-existent ovarian cysts. For evaluation of estrogen receptor (ER) status immunohistochemical stains were applied and H-scoring system was used with a score >50 as positive.Results:Out of the 100 hysterectomy specimens, 25 cases had both adenomyosis and ovarian cysts. The ER status of adenomyotic foci was positive in 20% cases and negative in 80% cases. The commonest type of ovarian cyst was hemorrhagic luteal cyst (28%), followed by serous and mucinous cystadenoma (20%) each. Out of the 28% cases of functional cysts, 71.5% were ER positive and 28.5% were ER negative. The p-value for association of ER status of adenomyotic foci with functional cysts was 0.0004; however, p-value was not significant in comparing cases with controls. All 72% cases of nonfunctional cysts were ER negative. However, 44% of functional cysts were not associated with adenomyotic foci.Conclusion:This study concludes that besides functional ovarian cysts, other local factors may be responsible for the development of adenomyosis.

Incidence of Adenomyosis and its association with other benign lesions in Hysterectomy with BSO.

“…Adenomyosis may mask other associated pathological conditions as leiomyomas, endometrial or adenomy-omatous Polyps, endometrial hyperplasia and endometritis, so it may cause difficulty in the management 9 . It has been reported that adenomyotic foci were ER positive in 71.5% of cystic follicles and follicular cysts, but all the adenomyotic foci associated with nonfunctional cysts were ER negative 6 . In our study cystic follicles and follicular cysts associated with adenomyosis were 57.1%.…”

“…The adenomyosis is a common condition in middle aged women, who undergone hysterectomy due to dysmenorrhea, menorrhagia and chronic pelvic pain. In literature it had been reported that incidence and prevalence of adenomyosis is 5-70% [5][6][7] . In our study 39.6% cases were found.…”

“…The microscopic findings were recorded. The criteria for diagnosis of adenomyosis was the presence of the endometrial glands, stroma or both at one and half low power field (2.5mm) below the junction of endometrium and hypertrophied or plump smooth muscle fibers surrounding the endometrial tissue deep in the myometrium 6 . Adenomyosis and its association with other lesions.…”