Difficulties in diagnosing nodular and diffuse adenomyosis


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Abstract

Objective. To determine the diagnostic possibilities of USG and MRI for nodular and diffuse adenomyosis and to study their proliferative activity. Subjects and methods. One hundred and fifty women diagnosed with adenomyosis were examined. Preoperative USG and MRI were performed. All the patients were operated on. Intraoperative biopsy specimens were histologically and immunohistochemically explored. The expression of Ki-67 and P16 in the epithelium, stroma of heterotopias, and adjacent myometrium was studied. The immunohistochemical analysis used monoclonal antibodies against the Ki-67 antigen (DAKO) at a dilution of 1:100, those against the P16 INK antigen (DAKO) at a dilution of 1:100 with the previous thermal unmasking of antigen retrieval solution pH 6.0 and with the use of streptavidin-biotin and DAB. Results. USG for diffuse adenomyosis is of more informative value than that for nodular adenomyosis and can correctly verify the abnormality in more than 90% of cases. According to our data, the sensitivity of ultrasound scanning in diagnosing nodular adenomyosis was 69.3%. MRI can identify adenomyosis with a high accuracy and define its form. The immunohistochemical examination revealed the similar level of Ki-67 and P16 expressions in nodular and diffuse adenomyosis. Conclusion. Thus, reproductive-aged patients planning to preserve reproductive function who had suspected nodular adenomyosis concurrent with other pathological processes should undergo MRI after MRI to specify the site of a nodule and to clearly determine its borders. By taking into account the fact that there are no changes in the expression of the proliferation markers Ki-67 and anti-oncogene P-16, it can be inferred that diffuse and nodular adenomyosis have the same proliferative activity.

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About the authors

Alexei A. Shklyar

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: Doctorshklyar@gmail.com
postgraduate, department of operative gynecology

Leila V. Adamyan

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: Adamyanleila@gmail.com
Academician of the Russian Academy of Sciences, MD, PhD, Professor, Honored Master of Science of the Russian Federation, Head Specialist in Obstetrics and Gynecology of Ministry of Healthcare and Social Development of Russia, Head of the Department of Surgical Gynecology of Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Head of the Department of Reproductive Medicine and Surgery, Faculty of Postgraduate Education, Moscow State University of Medicine and Dentistry.

Eugene A. Kogan

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: E_kogan@oparina4.ru
MD, Professor, Head of Pathology Department

Nina B. Paramonova

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: E_kogan@oparina4.ru
Ph.D., researher of the 1st anatomopathological department

Irena F. Kozachenko

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

MD at the Department of Operative Gynecology

Tatiana Yu. Gavrilova

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

MD at the Department of Operative Gynecology

Stanislav N. Kononov

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: ckononov@list.ru
postgraduate, department of operative gynecology

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