Extrinsic Adenomyosis Is Associated With Postoperative Recurrence of Ovarian Endometrioma

Abstract

Objective: To determine whether endometrioma recurrence is closely related to the presence of extrinsic adenomyosis, which was demonstrated by magnetic resonance imaging (MRI).Design: Observational crosssectional study involving patients with the recurrence of ovarian endometrioma (OMA). Correlations of endometrioma recurrence and adenomyosis subtypes shown by MRI were analyzed.Method: Between January 2018 and December 2020, a total of 233 patients with recurrence of OMA after ovarian cystectomy were administered for surgery at our institution. All patients were divided into subtype II (Group A), subtype I+IV (Group B), and nonadenomyosis (Group C) groups at preoperative MRI imaging. The correlations of endometrioma recurrence with clinical features, imaging appearance, and surgical findings were retrospectively analyzed.Results: We found 112 (48.07%) patients of endometrioma recurrence combined with subtype II adenomyosis, 8 (3.43%) subtype I adenomyosis, 47 (20.17%) subtype IV adenomyosis, 66 (28.32%) nonadenomyosis. The mean time of OMA recurrence (44.28 ± 8.37, vs. 63.96 ± 10.28, vs. 69.36 ± 9.34 mon), rate of pain symptoms (85.71, vs. 69.10, vs. 18.18%), and primary infertility (31.25, vs. 14.55, vs. 10.77%) were higher in Group A. Uterine volume (257.37± 42.61, vs. 203.14 ± 33.52, vs. 100.85 ± 26.67 cm3), and mean OMA size (4.97 ± 2.25, vs. 4.36 ± 2.38, vs. 4.46 ± 2.70 cm) were significantly larger in Group A. The rate of DIE (83.93, vs. 45.45, vs. 40.91%), the number of DIE (3.6 ± 1.8 vs. 2.3 ± 1.5 vs. 2.2 ± 1.3), the mean total revised American Society for Reproductive Medicine score (rASRM, 103.14 ± 23.89 vs. 74.23 ± 16.72 vs. 36.51 ± 14.23) were significantly higher in Group A. After a multiple logistic regression analysis, extrinsic adenomyosis (OR 2.5, 95% CI 1.2–3.4), DIE lesions (OR 2.1, 95% CI 1.4–2.8), and primary infertility (OR 1.8, 95% CI 1.3–4.3) were significantly associated with early recurrence (in 3-year) of OMA.Conclusions: Extrinsic adenomyosis was associated with postoperative recurrence of OMA. In addition, a pathogenic link between extrinsic adenomyosis and pelvic endometriosis needs to be clarified.

Status and related factors of postoperative recurrence of ovarian endometriosis: a cross-sectional study of 874 cases

“…In our study, the presence of adenomyosis is another independent risk factor for the recurrence of endometrioma. Sun Man et al [ 21 ] found that extrinsic adenomyosis was significantly correlated with the early recurrence of endometrioma. Libo Zhu et al found that the recurrence rate of AM combined with EM at 6 years after operation was higher than that of AM alone group [ 22 ], indicating that EM and AM influenced each other.…”

Exophytic Subserosal Uterine Adenomyomatous Polyp Mimicking Malignancy: A Case Report

“…Hence, the distinctive imaging features and various MRI-based subtypes of adenomyosis [11,12], which can pose a diagnostic dilemma, must be recognized. Extrinsic adenomyosis was significantly correlated with early ovarian endometrioma recurrence in less than three years [19]. In co-existing endometriosis and adenomyosis cases, patients must be informed about its chronic nature, potentially affecting the long-term overall quality of life, including mental health, social activities, and partner relationships.…”

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

“…However, patients with extensive adenomyosis were not considered for surgery [13] (Figure 1). Uterus and adenomyotic lesions were treated as triaxial ellipsoids; their volumes were calculated using the following formula: volume = 0.523 × longitudinal diameter × anteroposterior diameter × transverse diameter [14].…”