Evaluation of Adenomyosis and Accompanying Endometrial Abnormalities: Retrospective Analysis of a 3-Year Clinical Experience

Öz

Aim: To investigate other endometrial and myometrial pathologies accompanying cases of adenomyosis to which TAH / TAH + BSO Total Abdominal Hysterectomy/ Total Abdominal Hysterectomy +Bilateral Salpingooforectomia were performed in our hospital.Material and Methods: Of the 2954 patients who were treated with hysterectomy in our hospital between January 2009 and December 2011 with different indications such as therapy resistant menometrorrhagia, uterine myoma, pelvic organ prolapse, endometrial hyperplasia, pelvic mass, and endometrial cancer, 650 cases were diagnosed with adenomyosis and are included in this study. The other endometrial pathologies accompanying adenomyosis were recorded. Age, gravidity, parity, menopausal status, and demographic data were evaluated.Results: Patients’ age ranged changed from 35 to 77 and the mean age was 50,2±5,79. The average number of gravida 4,2 ± 2,4 and the average number of parity was 2,9 ± 1,4. Most of the patients were aged between 45-55 %65,2 . Postoperative histopathological examination of the specimens revealed; 7,8% endometrial polyp, 7,8% endometrial hyperplasia, 5,4% atrophic endometrium, 1,2% endometrial cancer, 23,8% proliferative phase endometrium, 12% secretory phase endometrium, 8,2 %disordered proliferative endometrium and 33,7% other nonspecific findings along with adenomyosis.Conclusion: Adenomyosis is frequently seen disease and therefore may be associated with endometrial abnormalities. But evident endometrial pathology is not detected in ¾ of the endometrial biopsies of patients with adenomyosis. The most common concomitant endometrial pathologies are endometrial polyp and hyperplasia, the most common uterine pathology is uterine leiomyoma. In patients whose complaints persist even after local treatment of endometrial polyp and hyperplasia, possibility of adenomyosis should be considered. This association should be kept in mind in treatment planning.

Anahtar Kelimeler

• Adenomyosis,endometrial polyp,endometrial hyperplasia,leiomyoma,hysterectomy

Adenomyozis ve Adenomyozise Eşlik Eden Endometrial Patolojilerin Değerlendirilmesi: 3 Yıllık Klinik Tecrübemizin Retrospektif Analizi

Öz

Amaç: Hastanemizde, TAH/TAH+BSO Total Abdominal Histerektomi / Total Abdominal Histerektomi+Bilateral Salpingooforektomi yapılan ve patoloji sonucu adenomyozis olarak gelen olgularda, eşlik eden endometrial ve myometrial patolojileri araştırmak.Gereç ve Yöntemler: Hastanemizde, Ocak 2009–Aralık 2011 yılları arasında tedaviye dirençli menometroraji, myoma uteri, pelvik organ prolapsusu, endometrial hiperplazi, pelvik kitle ve endometrium kanseri gibi farklı endikasyonlarla histerektomi uygulanan 2954 hastadan, histopatolojik tanısı adenomyozis olarak bildirilen 650 olgu çalışmamıza dahil edildi. Bu hastaların histopatolojik sonuçlarında adenomyozise eşlik eden endometrial patolojiler kaydedildi. Yaş, gravida, parite ve menopozal durum gibi demografik veriler değerlendirildi.Bulgular: Hastaların yaş aralığı 35-77 arası değişmekte olup ortalama yaş 50,2±5,79; ortalama gravida sayıları 4,2±2,4 ve ortalama parite sayıları 2,9±1,4 olarak belirlendi. Hastaların yaş dağılımına bakıldığında 45-55 %65,2 yaş arası hasta populasyonunun daha fazla olduğu tesbit edildi. Postoperatif patoloji spesmenlerin histopatolojik incelemesinde; %7,8 endometrial polip, %7,8 endometrial hiperplazi, %5,4 atrofik endometrium, %1,2 oranında endometrial kanser, %23,8 proliferatif faz endometrium, %12 sekresyon faz endometrium, %8,2 düzensiz proliferatif endometrium ve %33,7 oranında diğer nonspesifik endometrial bulguların adenomyozise eşlik ettiği tesbit edildi.Sonuç: Adenomyozis sık izlenen bir hastalıktır ve bu nedenle endometrial patolojiler ile beraber izlenebilmektedir. Ancak adenomyozis hastalarının endometrial biopsilerinin ¾ ünde belirgin endometrial patoloji izlenmemektedir. En sık eşlik eden endometrial patoloji endometrial polip ve hiperplazi, en sık uterin patoloji ise leiomyomdur. Endometrial patolojilerin lokal tedavisinden sonra şikayetleri geçmeyen, tedaviye direnç gösteren hastaların adenomyozis açısından da sorgulanması uygun olacaktır. Tedavi planlamasında bu birliktelik dikkate alınmalıdır.

Anahtar Kelimeler

• Adenomyozis,endometrial polip,endometrial hiperplazi,leiyomyom,histerektomi

Kaynakça

1. Zaloudek C, Hendrickson MR. Mesenchymal tumors of theuterus. In Blausteins’ pathology of the female genital tract. Kurman RJ ed. Fifth edition, New York: Springer 2002:561-573
2. Azziz R. Adenomyosis: Current perspectives. Obstet Gynecol Clin North Am 1989;16:221–235.
3. Benagiano G, Brosens I. The endometrium in adenomyosis. Womens Health (Lond Engl) 2012;8:301-312.
4. Atri M, Reinhold C, Mehio AR, Chapman WB, Bret PM. Adenomyozis: US features with histologic correlation in an in vitro study. Radiology 2000;215:783-790.
5. McElin TW, Bird CC. Adenomyosis of the uterus. Obstet Gynecol Annu 1974;3:425.
6. Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenom- yosis in endometriosis prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 2005;20:2309-2316.
7. Leyendecker G, Wildt L, Mall G. The pathophysiology of endometri- osis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 2009;280:529–38.
8. Indraccolo U, Barbieri F. Relationship between adenomyosis and uterine polyps. European Journal of Obstetrics & Gynecology and Reproductive Biology 2011;157:185–189.