Pathogenesis of adenomyosis

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Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility.

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About the authors

Ekaterina K. Orekhova

ЕМС Ltd.; The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Author for correspondence.

Russian Federation, Saint Petersburg

MD; Post-Graduate Student (Applicant)


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Supplementary files

Supplementary Files Action
Fig. 1. Sagittal T2-weighted magnetic resonance image through the uterine corpus demonstrates the zonal anatomy of the uterus. The low-signal junctional zone can clearly be seen as a smooth uniform band separating the hyperintense endometrium from the intermediate-signal outer myometrium [14]

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Fig. 2. Ultrasonographic diagnostic criteria for adenomyosis: a — globulous aspect of the uterus: b — uterine asymmetry. Longitudinal section of a retroverted uterus, where the posterior uterine wall is clearly thicker than the anterior wall: c — heterogeneous myometrial texture. Transversal section of the uterus at the fundus level, where hypoechoic areas with radial pattern can be seen (indicated by arrows): d — linear striations. In this sagittal section of an anteverted uterus, thin hyperecogenic lines cross the myometrial thickness, visible from the endometrial-myometrial interphase (indicated by arrows): e — intramyometrial cysts. Transversal section of the uterus at the fundus level with sonoluscent images distributed in posterior wall of the myometrium (indicated by arrows): f — hyperechogenic nodules in the myometrial thickness (indicated by the arrow) [31]

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Fig. 3. Diffuse adenomyosis: sagittal T2-weighed image; thickening of the junctional zone forming an ill-defined area of low signal intensity, with punctate high-intensity myometrial foci (indicated by the arrow) [32]

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