Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma

INTRODUCTION@#To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions.@*METHOD@#Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period-from 2015 to 2021-were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only.@*RESULTS@#A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02-7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85-12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01-180.59) and a lower body mass index (OR 0.89, 95% CI 0.79-0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis.@*CONCLUSION@#Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.

Adenomiosis apendicular: reporte de dos casos / Appendicular adenomiosis: report of two cases

Resumen Los adenomiomas son tumoraciones benignas constituidas por un agregado nodular de músculo liso, glándulas endometriales y estroma endometrial. La presencia de adenomiomas fuera del útero es un hallazgo infrecuente. Presentamos dos casos de adenomiomas extrapélvicos localizados en el apéndice. El estudio histológico resultó esencial para el diagnóstico.

Abstract Adenomyomas are a benign tumor compound of smooth muscle nodular aggregate, endometrial glands and endometrial stroma. Adenomyomas presenting outside uterus are a rare finding. Here we report two extrapelvic adenomyomas of the appendix. Histological examination was essential for diagnosis.

Histopathological findings of abdominal hysterectomies in patients presenting with heavy menstrual bleeding [HMB]

To determine the frequency of different histopathological findings in hysterectomy specimens in patients with heavy menstrual bleeding. Cross-sectional study This study was carried out in Gynae Unit III [Sandemen Provincial Teaching Hospital Quetta] from January 2009- December 2009. Two hundred abdominal Hysterectomy cases done for the treatment of heavy menstrual bleeding [HMB] were included in this study. An exclusion criteria was vaginal hysterectomies, abdominal hysterectomies done for complaints other than manorrhagia and malignancies. After hysterectomy specimen of uterus sent for histopathology. The age ranged from 30-55 years with maximum number [62.5%] of cases in 41-50 years of age group. The main presenting complaint of patients was heavy cyclical menstrual flow. Total abdominal Hysterectomies with bilateral salpingoophoroctomy done in 120patients, in 80 patients both ovaries conserved. There was no intra-operative complication. Mild post operative complications occurred in 15% of cases. There was no death. On histopathology leiomyoma was most common pathlogy found in 55% cases. No malignancy was detected on histopathology of the uterus. The study confirmed that benign diseases were more common in hysterectomy specimen performed for HMB. Uterine fibroids and adenomyosis are the most common benign conditions found in hysterectomy specimens on histopathological examination