Pathomorphological Analysis of Internal Endometriosis

Abstract

We performed clinical and morphological examination of 59 women with internal endometriosis (adenomyosis). Women were found to develop adenomyosis more frequently in the perimenopausal period (in their 40s) after repeated abortions and diagnostic surgical procedures. In 90% patients, adenomyosis was associated with the formation of multiple leyomyomatous nodules; glandular hyperplasia of the endometrium and fibrocystic transformation or fibrous degeneration of the ovaries were found in 60 and 100% cases. Two morphological variants of adenomyosis were identified: invasion of cytogenic stroma into the underlying myometrium with the formation of endometrial glands and invasion of cytogenic stroma via connective tissue interlayers without formation of endometrial glands and with pronounced neoangiogenesis. Foci of active adenomyosis in the uterus with predominance of cytogenic stroma were most prevalent in the late reproductive period. Endometrioid heterotopias were accompanied by considerable structural and functional reorganization of the myometrium with the formation of multiple leyomyomatous nodules. The presence of active and inactive adenomyosis foci and leyomyomatous nodules in uterus specimens reflects their metachronous development.

Immunocytochemical Analysis of Proliferative Activity of Endometrial and Myometrial Cell Populations in Focal and Stromal Adenomyosis

“…In a previous analysis of the morphology of endometrioid heterotopies in the uterus we have distinguished two morphological variants of adenomyosis: focal (with the formation of endometrioid glands, "glandular") and stromal (without formation of endometrioid structures, "cytogenic") [6,7]. Focal adenomyosis, characterized by appearance in the myometrium of endometrioid cytogenic stroma with endometrioid glands and sinusoidal vessels, is more incident (65% in our study).…”

Expression of CXCL12 and its receptor CXCR4 in patients with adenomyosis

“…The incidence of pregnancy, delivery, abortion and intrauterine device use has been demonstrated to be increased in patients with AD compared with healthy controls, thus supporting the theory of endometrial damage (4,5). Furthermore, surgeries, including cesarean sections and the removal of uterine fibroids, are considered pathogenic risk factors of AD (6). However, the mechanism by which endometrial cells invade the myometrium through the damaged endomembrane and proliferate ectopically remains unclear.…”