Biological differences between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis

Khan, Khaleque Newaz; Fujishita, Akira; Koshiba, Akemi; Kuroboshi, Haruo; Mori, Taisuke; Ogi, Hiroshi; Itoh, Kyoko; Nakashima, Masahiro; Kitawaki, Jo

doi:10.1016/j.rbmo.2019.03.210

Cited by 49 publications

(53 citation statements)

References 28 publications

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“…This finding points to the possibility that infiltration of the pelvic endometriosis from the uterine serosa to the myometrium may be involved in the onset of extrinsic adenomyosis. In fact, there are biological differences between the intrinsic and extrinsic lesion types [31]. The intramural type, which was not observed in any of the participants in our study, develops from Müllerian remnants, as opposed to being formed by infiltration of the endometrium or endometriotic tissues.…”

Section: Discussioncontrasting

confidence: 47%

Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study

Iwasawa

Takahashi

Maeda

et al. 2021

Reprod Biol Endocrinol

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Background Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. The effect of its localisation on IVF/ICSI-ET outcomes is unclear. This study aimed to investigate whether adenomyotic lesion localisation, assessed using magnetic resonance imaging (MRI), was associated with outcomes of IVF/ICSI-ET cycles. Methods This multicentre, joint, retrospective cohort study analysed the medical records of 67 infertile patients with adenomyosis who underwent IVF/ICSI with fresh and frozen-thawed ET at five participating facilities from January 2012 to December 2016 and for whom MRI data were available. Fifteen patients were excluded; therefore, the MRI data of 52 patients were evaluated by two radiologists. We assessed the localisation of and classified adenomyotic lesions into advanced (invades the full thickness of the uterine myometrium), extrinsic (localised on the serosal side), and intrinsic (localised on the endometrial side) subtypes. Results There were 40 advanced, nine extrinsic, and three intrinsic cases, and the outcomes of 100, 27, and nine ET cycles, respectively, were analysed. Pregnancy loss/clinical pregnancy and live birth rates of the advanced, extrinsic, and intrinsic groups were 64 % (16/25) and 9 % (9/100), 33.3 % (3/9) and 22.2 % (6/27), and 50 % (1/2) and 11.1 % (1/9), respectively. A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses (odds ratio 0.06; 95 % confidence interval [CI]: 0.00–0.54, p = 0.026) and more live births (odds ratio 6.05; 95 % CI: 1.41–29.65, p = 0.018) than the advanced group. Conclusions Adenomyotic lesions exert different effects on IVF/ICSI-ET outcomes. Thus, MRI assessments of adenomyosis in infertile patients are beneficial. Establishment of treatment plans based on adenomyotic lesion localisation should be considered.

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Section: Discussioncontrasting

confidence: 47%

Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study

Iwasawa

Takahashi

Maeda

et al. 2021

Reprod Biol Endocrinol

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“…Imaging studies have also shown an increased incidence of deeply infiltrative endometriosis and ovarian endometriomas in women with adenomyosis, specifically in adenomyosis involving the outer portion of the myometrium. [71][72][73] This suggests that adenomyosis and certain types of endometriosis may be biologically related.…”

Section: Pathogenesis Of Adenomyosismentioning

confidence: 99%

Pathology and Pathogenesis of Adenomyosis

et al. 2020

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Adenomyosis represents a unique pathophysiological condition in which normal-appearing endometrial mucosa resides within myometrium and is thus protected from menstrual shedding. The resulting ectopic presence of endometrial tissue composed of glands and stroma is thought to affect normal contractile function and peristalsis of uterine smooth muscle, causing menometrorrhagia, infertility, and adverse obstetric outcomes. Since the first description of adenomyosis more than 150 years ago, pathologists have studied this lesion by examining tissue specimens, and have proposed multiple explanations to account for its pathogenesis. However, as compared with endometriosis, progress of adenomyosis research has been, at best, incremental mainly due to the lack of standardized protocols in sampling tissue and a lack of consensus diagnostic criteria in pathology practice. Despite these limitations, recent advances in revealing the detailed anatomy and biology of eutopic endometrium offer an unprecedented opportunity to study this common but relatively understudied disorder. Here, we briefly summarize the pathological aspects of adenomyosis from an historical background, and discuss conventional morphology and recent tissue-based molecular studies with a special emphasis on elucidating its tissue of origin from a pathologist's perspective. We also discuss unmet needs in pathology studies that would be important for advancing adenomyosis research.

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“…Donnez et al found that external adenomyosis patients had a high rate (97%) of deep infiltrating endometriosis (20). Khan et al reported that extrinsic adenomyosis has a close biological and histological correlation with co-existent deep infiltrating endometriosis (21). It is highly suspect of a shared drug treatment protocol for long-term administration in two diseases.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study

Chen¹,

Wang²,

Sun³

et al. 2020

Ann Transl Med

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Background: Although the levonorgestrel-releasing intrauterine device (LNG-IUD) has been widely applied in the treatment of adenomyosis, not all the patients are satisfied with its efficacy. The present retrospective study aimed to investigate the efficacy of LNG-IUD on different subtypes of adenomyosis. Methods:The study comprised a cohort of 207 patients who received the LNG-IUD at the Women's Hospital, Zhejiang University School of Medicine, China, from June 2013 to June 2016. Different subtypes of adenomyosis were classified by magnetic resonance imaging (MRI) and patients were subcategorized into three groups (subtype I: intrinsic, n=70; subtype II: extrinsic, n=73; subtype IV: indeterminate, n=64).Multiple variables were compared among the different groups.Results: Patient demographics, clinical features and the treatment effects of the LNG-IUD were compared between the three subtype groups. The numeric rating scale (NRS) and pictorial blood loss assessment chart (PBAC) score markedly decreased after insertion of the LNG-IUD compared with baseline in all patients in the three subtype groups (P<0.001 for all groups). Compared to the other two subtypes, the efficacy rate was lower and the spontaneous expulsion rate was higher in subtype IV adenomyosis patients than that in other two groups (P<0.05). The independent factor associated with the spontaneous expulsion of the system was suggested to be uterine size before IUD placement and bleeding amount after LNG-IUD treatment in the subtype I [P=0.029, hazards ratio (HR): 3.37, 95% confidence interval (CI): 1.09-6.88] and IV (P=0.045, HR:1.02, 95% CI: 1.01-1.21) adenomyosis patients respectively. Conclusions:The LNG-IUD is proved to be an effective approach to treat subtype I and II adenomyosis.However, further study is warranted to explore a more suitable protocol to treat this subtype IV adenomyosis due to the high incidence of treatment failure and expulsion.

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Biological differences between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis

Cited by 49 publications

References 28 publications

Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study

Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study

Pathology and Pathogenesis of Adenomyosis

Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study

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