Occurrence of chronic endometritis in different types of human adenomyosis

Khan, Khaleque Newaz; Fujishita, Akira; Ogawa, Kanae; Koshiba, Akemi; Mori, Taisuke; Itoh, Kyoko; Nakashima, Masahiro; Kitawaki, Jo

doi:10.1002/rmb2.12421

Cited by 12 publications

(13 citation statements)

References 61 publications

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“…A number of epidemiological studies have shown that both a history of uterine surgery and multiple births are risk factors for AM [24][25][26]. Another study has suggested macrophage in ltration in the endometrium may be signi cantly higher in intrinsic AM than in extrinsic AM [27]. Our study found that the education level of the patients, gravidity, and number of endometrial curettage are all factors closely related to intrinsic AM.…”

Section: Discussionsupporting

confidence: 59%

Differences clinical characteristics and factors in intrinsic and extrinsic adenomyosis

Yan

Shi

Sun

et al. 2023

Preprint

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Adenomyosis (AM) is a common gynecological condition that can be classified into different subtypes. This study aimed to evaluate the clinical characteristics, factors and treatment effect in women who diagnosed with intrinsic or extrinsic AM by MRI and underwent hysterectomies. A total of 181 women were enrolled in the study. Among these, 77 of which were identified to be in the intrinsic AM group (intrinsic group) and 54 in the extrinsic AM group (extrinsic group). Our results show that gravidity (P < 0.0001), parity (P < 0.0001), number of abortion (P < 0.0013) and endometrial curettage (P = 0.0167) were significantly higher in the intrinsic group, while the education level was lower in the intrinsic group (P = 0.0118). Women in the extrinsic group had earlier menarches (P = 0.0257) and were more coexist with ovarian endometrioma (OMA) (P < 0.0001) and deep infiltrating endometriosis (DIE) (P < 0.0001). In terms of clinical features, dysmenorrhea was more serious in the extrinsic group (P = 0.0091), whereas women in the intrinsic group had heavier menstrual volume (P < 0.0001). Surgery duration (P < 0.0001), surgical bleeding (P < 0.0013), hospitalization cost (P < 0.0001), and postoperative medical therapy (P < 0.001) were significantly higher in the extrinsic group than in the intrinsic group. In the multivariate analysis we performed, education level, gravidity and number of endometrial curettage were significantly associated with intrinsic AM. OMA and DIE were closely related to extrinsic AM. These results suggest that intrinsic and extrinsic AM have specific clinic characteristics, are associated with different factors, and may have different pathogenesis.

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Section: Discussionsupporting

confidence: 59%

Differences clinical characteristics and factors in intrinsic and extrinsic adenomyosis

Yan

Shi

Sun

et al. 2023

Preprint

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“…These findings suggest that the eutopic endometria of patients with adenomyosis are recognized as a low-grade inflammatory state due to overexpression of TLRs and that a different expression spectrum of the upper genital tract microbiota may be implicated in disease development. Indeed, the incidence of chronic endometritis was higher in women with adenomyosis (approximately 60%) compared to control women (10%) [ 115 ]. Dysbiosis of endometrial microbiota may promote adenomyosis risk, possibly through an aberrant expression of inflammatory cytokines and chemokines ( Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

Endometrial Inflammation and Impaired Spontaneous Decidualization: Insights into the Pathogenesis of Adenomyosis

Kobayashi

2023

IJERPH

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Adenomyosis is an estrogen-dependent gynecologic disease characterized by the myometrial invasion of the endometrial tissue. This review summarized the current understanding and recent findings on the pathophysiology of adenomyosis, focusing on repeated menstruation, persistent inflammation, and impaired spontaneous decidualization. A literature search was performed in the PubMed and Google Scholar databases from inception to 30 April 2022. Thirty-one full-text articles met the eligibility criteria. Repeated episodes of physiological events (i.e., endometrial shedding, damage, proliferation, differentiation, repair, and regeneration) during the menstrual cycle are associated with inflammation, angiogenesis, and immune processes. The decidualization process in humans is driven by the rise in progesterone levels, independently of pregnancy (i.e., spontaneous decidualization). Adenomyotic cells produce angiogenic and fibrogenic factors with the downregulation of decidualization-associated molecules. This decidualization dysfunction and persistent inflammation are closely related to the pathogenesis of adenomyosis. Recently, it has been found that the reproductive tract microbiota composition and function in women with adenomyosis differ from those without. An increase in opportunistic pathogens and a decrease in beneficial commensals may promote impaired defense mechanisms against inflammation and predispose women to uncontrolled endometrial inflammation. However, currently, there is no direct evidence that adenomyosis is linked to pre-existing inflammation and impaired spontaneous decidualization. Overall, persistent inflammation, impaired spontaneous decidualization, and microbiota dysbiosis (i.e., an imbalance in the composition and function of endometrial microbiota) may be involved in the pathophysiology of adenomyosis.

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“…(iii) Impairment of implantation may result from inflammation, a lack of adequate expression of adhesion molecules (integrins), reduced expression of implantation markers, such as leukemia inhibitory factor (LIF), and altered function of the gene for embryonic development (HOXA10) [ 185 ]. (iv) Occurrence of chronic endometritis (CE) resulting from intrauterine microbial infection may be associated with negative fertility outcome in women with adenomyosis [ 186 ].…”

Section: Association With Infertilitymentioning

confidence: 99%

“…A recent study provides the first piece of clinical evidence that a variable rate of chronic endometritis (CE) occurs in women with different types of adenomyosis, such as focal and diffuse adenomyosis [ 192 ]. Although an insignificant difference in the occurrence of CE was found between focal (58.8%) and diffuse adenomyosis (60.0%), the ipsilateral side of focal adenomyosis showed a significantly higher occurrence of CE (58.8%) than the contralateral side (11.7%) [ 186 ]. These findings indicated that a variable occurrence of CE in different types of adenomyosis may be involved in negative fertility outcome.…”

Section: Association With Infertilitymentioning

confidence: 99%

Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility

Khan

Fujishita

Mori

2022

JCM

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The aim of this review article was to summarize our current understanding on the etiologies and pathogenesis of human adenomyosis and to clarify the relative association between adenomyosis and infertility. The exact pathogenesis of adenomyosis is still elusive. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into myometrium is the most widely accepted opinion on the development of adenomyosis. According to this concept, endometrial epithelial cells and changed fibroblasts, abnormally found in the myometrium in response to repeated tissue injury and/or disruption at the endometrium-myometrium interface (EMI), elicit hyperplasia and hypertrophy of the surrounding smooth muscle cells. In this review, a comprehensive review was performed with a literature search using PubMed for all publications in English and Japanese (abstract in English), related to adenomyosis and infertility, from inception to April 2021. As an estrogen-regulated factor, hepatocyte growth factor (HGF) exhibits multiple functions in endometriosis, a disease commonly believed to arise from the functionalis endometrium. As a mechanistic basis of gland invagination, we investigated the role of HGF, either alone or in combination with estrogen, in the occurrence of epithelial-mesenchymal transition (EMT) in adenomyosis. Aside from microtrauma at the EMI, metaplasia of displaced Müllerian remnants, differentiation of endometrial stem/progenitor cells within the myometrium and somatic mutation of some target genes have been put forward to explain how adenomyosis develops. In addition, the possible role of microRNAs in adenomyosis is also discussed. Besides our knowledge on the conventional classification (focal and diffuse), two recently proposed classifications (intrinsic and extrinsic) of adenomyosis and the biological differences between them have been described. Although the mechanistic basis is unclear, the influence of adenomyosis on fertility outcome is important, especially considering the recent tendency to delay pregnancy among women. Besides other proposed mechanisms, a recent transmission election microscopic (TEM) study indicated that microvilli damage and an axonemal alteration in the apical endometria of human adenomyosis, in response to endometrial inflammation, may be involved in negative fertility outcomes. We present a critical analysis of the literature data concerning the mechanistic basis of infertility in women with adenomyosis and its impact on fertility outcome.

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Occurrence of chronic endometritis in different types of human adenomyosis

Cited by 12 publications

References 61 publications

Differences clinical characteristics and factors in intrinsic and extrinsic adenomyosis

Differences clinical characteristics and factors in intrinsic and extrinsic adenomyosis

Endometrial Inflammation and Impaired Spontaneous Decidualization: Insights into the Pathogenesis of Adenomyosis

Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility

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