Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study.

OBJECTIVES: To investigate the association between adenomyosis and placenta accreta spectrum (PAS) and to evaluate the effect of assisted reproductive technology (ART) in mediating this association. METHODS: We retrieved data for singleton women from the Japanese nationwide perinatal registry between 2013 and 2019, excluding women with a history of adenomyomectomy. To investigate the association between adenomyosis and PAS among women, we used a multivariable logistic regression model with multiple imputation for missing data. We evaluated mediation effect of ART including in vitro fertilization and intracytoplasmic sperm injection on the association between adenomyosis and PAS using causal mediation analysis based on the counterfactual approach. RESULTS: Of 1 500 173 pregnant women, 1539 (0.10%) had adenomyosis. The number receiving ART was 489/1539 (31.8%) and 117 482/1 498 634 (7.8%) in women with and without adenomyosis, respectively. The proportion of women who developed PAS was 21/1539 (1.4%) in women with adenomyosis and 7530/1 498 634 (0.5%) in women without adenomyosis. Adenomyosis was significantly associated with PAS (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.26-3.00; P = 0.002). Mediation analysis showed that OR of the total effect of adenomyosis on PAS was 1.98 (95% CI 1.13-3.04), OR of natural indirect effect (effect explained by ART) was 1.15 (95% CI 1.01-1.41), and OR of natural direct effect (effect unexplained by ART) was 1.72 (95% CI 0.86-2.82). The proportion mediated (natural indirect effect/total effect) was 26.5%. Adenomyosis was also significantly associated with PAS without previa (OR 1.96; 95% CI 1.23-3.13, P = 0.005). CONCLUSION: Adenomyosis was significantly associated with PAS. ART mediated 26.5% of the association between adenomyosis and PAS.

Knowledge, attitudes, and practices among Chinese reproductive-age women toward uterine adenomyosis.

Objective: This study aimed to assess the knowledge, attitudes and practices (KAP) among Chinese reproductive-age women toward uterine adenomyosis. Methods: This web-based cross-sectional study was conducted between April 2023 and September 2023 at the Second Hospital of Hebei Medical University. A self-designed questionnaire was developed to collect demographic information of reproductive-age women, and assess their KAP toward uterine adenomyosis. Results: A total of 520 valid questionnaires were collected. Among the participants, 127 (24.42%) were diagnosed with uterine adenomyosis, and 120 (23.08%) were accompanied by uterine fibroids. The mean knowledge, attitudes and practices scores were 3.54 ± 3.72 (possible range:0-10), 20.96 ± 3.19 (possible range:5-25) and 24.01 ± 4.95 (possible range:7-35), respectively. The structural equation model demonstrated that knowledge had direct effects on attitudes and practices, as indicated by a path coefficient of 0.714 (p < 0.001) and 1.510 (p < 0.001), respectively. Moreover, attitudes had direct effects on practices, with a path coefficient of 0.226 (p = 0.001). Conclusion: The findings revealed that reproductive-age women have insufficient knowledge, negative attitudes, and poor practices toward the uterine adenomyosis. Comprehensive training programs are needed to improve reproductive-age women practices in this area.

Endometriosis and adenomyosis: Similarities and differences.

Deep endometriosis and uterine adenomyosis are two frequently encountered conditions affecting approximately 200 million women worldwide. They are closely related, showing similar histological patterns and multiple common pathogenic features, and share the same symptoms. It is therefore not surprising that they are often thought to have a common developmental origin. Indeed, both deep endometriosis and adenomyosis appear to derive from estrogen-dependent overproliferation of endometrial tissue and its subsequent implantation in ectopic sites. Although the scientific community has shown increasing interest in these diseases over recent years, neither pathogenesis has yet been elucidated, so there are currently no efficient treatment options. Understanding the mechanisms underlying disease development, as well as discerning their relationship, are key to improving clinical management for millions of patients. The aims of this review are to summarize current knowledge on deep endometriosis and adenomyosis pathogeneses and discuss the possibility that these two entities are actually differential phenotypes of the same disease.

Laparoscopic Hysterectomy for Uterine Adenomyosis in Patients With a History of Renal Transplant: A Case Report and Review of Literature.

Renal transplantation is a viable treatment option for patients with end-stage kidney disease; however, it requires careful surgical manipulation as the transplanted kidney is placed in the iliac fossa. Herein, we report a case of a 41-year-old female with a history of two renal transplants who presented with hypermenorrhea and dysmenorrhea. Computed tomography revealed transplanted kidneys in the bilateral iliac fossae (right atrophic), and magnetic resonance imaging showed uterine adenomyosis. Three-dimensional computed tomography was performed to determine the relationship between the arteriovenous vessels, iliac vessels, and ureter of the transplanted left kidney. A diamond-shaped trocar was inserted while monitoring the transplanted kidney. Total laparoscopic hysterectomy and bilateral salpingectomy were performed without any perioperative complications. Immunosuppressants were continued postoperatively. Laparoscopic surgery for gynecological diseases can be advantageous and should be considered in patients who underwent renal transplants.

Advanced Laparoscopic Adenomyomectomy Technique for Focal Uterine Adenomyosis by Three-step Approach.

Background and Objective: Owing to the increasing trend of preserving fertility in adenomyomectomy, the need for laparoscopic adenomyomectomy has increased. This study aimed to introduce a new surgical technique, an advanced laparoscopic adenomyomectomy technique, and to evaluate its efficacy, benefits, and safety in focal uterine adenomyosis. Methods: From February 1, 2019 to February 29, 2020, 47 patients who underwent laparoscopic adenomyomectomy using the new surgical technique were enrolled in the study. The inclusion criteria were: (1) Focal-type adenomyosis, diagnosed by ultrasound or magnetic resonance imaging that was refractory to medical treatments. (2) A strong desire to preserve the uterus. All the operations were performed by a single surgeon with a uniform technique. Results: The mean patient age was 40.53 ± 5.93 years (median 38.5, range 32-47). The mean diameter of the adenomyoma lesions was 4.57 ± 1.21 cm and the mean weight of the excised lesions was 40.53 ± 35.65g (range, 15-209 g). The mean total operation time was 70.11 ± 15.05 minutes. The mean estimated blood loss was 88.88 ± 20.0 mL (20 - 500 ml). There was no conversion to laparotomy or major complications requiring reoperation. At the seven-month follow-up, there was complete remission of dysmenorrhea and menorrhagia in 97.4% and 88.9% of the patients, respectively. Conclusions: The new advanced laparoscopic adenomyomectomy technique with a three-step approach could be a safe and effective therapeutic method.

Multiple Cerebral Infarctions Complicating Deep Vein Thrombosis Associated With Uterine Adenomyosis: A Case Report and Literature Review.

We describe a 46-year-old woman who developed multiple cerebral infarctions in the left middle cerebral artery territory and deep vein thrombosis, presumably related to uterine adenomyosis. Uterine adenomyosis can cause coagulation abnormalities, as observed in Trousseau's syndrome. Along with previous reports, our case experienced a stroke during menstruation and presented with increased cancer antigen 125 (CA125) levels. A hysterectomy was performed to prevent the recurrence of cerebral infarction. Our case also had complicated deep vein thrombosis, which is also known as a complication of uterine adenomyosis. We consider cerebral infarction and deep vein thrombosis with uterine adenomyosis might be caused by a common mechanism, hypercoagulation. Hysterectomy requires careful discussion before undergoing it because of fertility problems, but it might be the most effective approach for preventing the recurrence of brain infarction derived from adenomyosis and may be effective for both cerebral infarction and deep vein thrombosis.

Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach.

Uterine adenomyosis is a commonly encountered estrogen-dependent disease in reproductive-age women, causing heavy menstrual bleeding, intense pelvic pain, and infertility. Although adenomyosis was previously considered a disease of multiparous women, it is becoming increasingly evident that it also affects younger nulliparous women and may compromise their fertility potential. It is clear that hysterectomy, the standard approach to definitively manage the disease, is not an option for patients wishing to preserve their fertility, so there is an urgent need to develop novel conservative strategies. We searched the current literature for available methods for conservative management of adenomyosis, including both pharmacological and surgical approaches. There is no existing drug that can cure adenomyosis at present, but some off-label treatment options may be used to tackle disease symptoms and improve fertility outcomes. Adenomyosis in patients wishing to conceive can be 'treated' by conservative surgery, though these procedures require highly experienced surgeons and pose a considerable risk of uterine rupture during subsequent pregnancies. While currently available options for conservative management of adenomyosis do have some capacity for alleviating symptoms and enhancing patient fertility perspectives, more effective new options are needed, with gonadotropin-releasing hormone antagonists showing encouraging results in preliminary studies.

Proceedings of the 2021 National Toxicology Program Satellite Symposium.

The 2021 annual National Toxicology Program (NTP) Satellite Symposium, entitled "Pathology Potpourri," was the 20th anniversary of the symposia and held virtually on June 25th, in advance of the Society of Toxicologic Pathology's 40th annual meeting. The goal of this symposium was to present and discuss challenging diagnostic pathology and/or nomenclature issues. This article presents summaries of the speakers' talks along with select images that were presented to the audience for voting and discussion. Various lesions and topics covered during the symposium included differentiation of canine oligodendroglioma, astrocytoma, and undefined glioma with presentation of the National Cancer Institute's updated diagnostic terminology for canine glioma; differentiation of polycystic kidney, dilated tubules and cystic tubules with a discussion of human polycystic kidney disease; a review of various rodent nervous system background lesions in control animals from NTP studies with a focus on incidence rates and potential rat strain differences; vehicle/excipient-related renal lesions in cynomolgus monkeys with a discussion on the various cyclodextrins and their bioavailability, toxicity, and tumorigenicity; examples of rodent endometrial tumors including intestinal differentiation in an endometrial adenocarcinoma that has not previously been reported in rats; a review of various rodent adrenal cortex lesions including those that represented diagnostic challenges with multiple processes such as vacuolation, degeneration, necrosis, hyperplasia, and hypertrophy; and finally, a discussion of diagnostic criteria for uterine adenomyosis, atypical hyperplasia, and adenocarcinoma in the rat.

Gonadotropin-releasing hormone antagonist (linzagolix): a new therapy for uterine adenomyosis.

OBJECTIVE: To compare the efficacy of a selective progesterone receptor modulator, ulipristal acetate, and a gonadotropin-releasing hormone antagonist, linzagolix, in a case of severe uterine adenomyosis. DESIGN: Case report. SETTING: Private clinic and infertility research unit. PATIENT: One patient born in 1981 who presented because of heavy menstrual bleeding, pelvic pain, and dysmenorrhea due to diffuse and disseminated uterine adenomyosis confirmed by magnetic resonance imaging (MRI). INTERVENTION: The patient received a first treatment of 5 mg UPA daily for one course of 3 months. This therapy was discontinued because MRI revealed a worsened aspect. One year later, a once-daily dose of 200 mg linzagolix administered orally was initiated for 3 months, followed by another 3-month course of 100 mg once daily. MAIN OUTCOME MEASURES: Clinical symptoms and MRI aspect. RESULTS: During treatment with UPA, the symptoms (pelvic pain, dysmenorrhea, bulk symptoms) worsened and MRI revealed aggravation of the adenomyotic lesions. During the 12-week course of once-daily 200 mg linzagolix, the patient remained in amenorrhea and noted a very significant improvement in symptoms. On MRI, the uterine volume had fallen from 875 cm3 to 290 cm3, and the adenomyotic lesions had significantly regressed. During the 100-mg linzagolix course (weeks 13-24), the patient reported continued alleviation of her symptoms. CONCLUSION: To our knowledge, this is the first reported use of linzagolix, a new oral gonadotropin-releasing hormone antagonist that significantly reduced lesion size and improved quality of life in a patient with severe adenomyosis, who was previously nonresponsive to treatment with a selective progesterone receptor modulator, ulipristal acetate.

Clear cell adenocarcinoma arising from the abdominal wall after cesarean section in a patient with uterine adenomyosis.

Malignant transformation of abdominal wall endometriosis lesions developed in a cesarean section scar is a rare event. Patients with uterine adenomyosis but without endometriosis can also develop abdominal wall malignant carcinoma after a gynecologic surgery. The treatment of abdominal wall clear cell adenocarcinoma combines tumor surgical excision with free margins, radiotherapy and chemotherapy. We report a case of clear cell carcinoma arising from an abdominal wall cesarean section scar in a patient without history of endometriosis.

Progress in the application and research of MRI in uterine adenomyosis / 中国实用妇科与产科杂志

Magnetic resonance imaging(MRI)is one of the important imaging methods for the female reproductive system.In recent years,its application value in uterine adenomyosis has been increasingly recognized in clinic.Due to its many advantages,such as clear and intuitive images,being independent of operators,multi-parameter and multi-planar imaging and so on,MRI has been mainly applied to the diagnosis and typing of uterine adenomyosis and the continuous monitoring after drug treatment.The purpose of this article is to review the manifestations and typing of uterine adenomyosis in MRI and the progress of MRI scanning technology.

Introduction: Uterine adenomyosis, another enigmatic disease of our time.

Like endometriosis, uterine adenomyosis is another enigmatic disease and remains a source of controversy. Uterine adenomyosis is characterized by the presence of endometrial glands in the myometrium. Two main theories may explain its pathogenesis: adenomyosis may arise from invagination of the myometrial basalis into the myometrium; or an alternative theory maintains that it may result from metaplasia of displaced embryonic pluripotent müllerian remants or differentiation of adult stem cells. Uterine adenomyosis is responsible for pelvic pain, abnormal bleeding, and infertility. Its diagnosis may be improved by high quality imaging. This issue's Views and Reviews, authors stress the urgent need to establish some systematic classification. Medical and surgical strategies are discussed. It should be emphasized that treatment should be designed according to a patient's symptoms and an individual's needs. Surgical treatment remains a matter of debate. Indeed, the risk of uterine rupture during pregnancy after adenomyomectomy is a reality. Therefore, continued research into new molecules based on the pathogenic mechanisms is vital.

A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women.

BACKGROUND: Uterine artery embolisation (UAE) is a possible uterine-sparing treatment option for women with unsuccessful conservative management for adenomyosis-related heavy menstrual bleeding (HMB) and dysmenorrhoea. AIM: To conduct a clinical audit on the efficacy and safety of UAE for symptomatic adenomyosis. MATERIALS AND METHODS: Retrospective review of 309 women who underwent UAE identified 117 women with magnetic resonance imaging features of adenomyosis (junctional zone thickness ≥ 12 mm). Overall success and HMB control were rated by women. Visual analogue scale (VAS) pain score, Uterine Fibroid Symptom and health-related Quality of Life (UFS-QoL) symptoms score and quality of life score were also used to measure outcome. RESULTS: One hundred and fifteen women (98%) were available for outcome evaluation. The mean follow-up was 22.5 months. Overall clinical success was achieved in 102/115 (89%) women; HMB control was achieved in 91/104 (88%); dysmenorrhea relief was achieved in 94/104 (90%), with VAS reduction of 6.13 (P < 0.001), Mean symptoms score was reduced from 58 to 17 at 12 months (P < 0.001) and QoL score increased from 42 to 88 at 12 months (P < 0.001). Hysterectomy was performed on six (5%) women. There were three (3%) mild groin haematomatas and three (3%) mild subacute complications (one possible endometritis, two urinary tract infections; all responded to oral antibiotics). Two women had unintended pregnancies which were complicated. CONCLUSIONS: In this clinical audit UAE was found to be an effective uterine-sparing option for women who had unsuccessful conservative treatments for adenomyosis-related HMB and dysmenorrhoea. There were no major complications. Two women had unintended pregnancies that were complicated.

Major diagnostic signs of magnetic resonance imaging for uterine adenomyosis / 第二军医大学学报

Objective To investigate the value of abnormal thickening of the junctional zone, and T1 weighted imaging (WI) and (or) T2WI hyperintense in magnetic resonance imaging (MRI) for the diagnosis of uterine adenomyosis. Methods The MRI images of 37 cases of adenomyosis confirmed by pathology in Changhai Hospital of Navy Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2016 were retrospectively analyzed, and 37 cases of normal uterus and ovary confirmed by MRI in the same period were randomly selected as controls. The maximal junctional zone thickness (JZmax), the difference between the smallest and largest junctional zone thickness (JZdiff), and the ratio of JZmax to maximal myometrium thickness (JZmax/ Mmax) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve of each parameter in diagnosis of adenomyosis was drawn, and the area under curve (AUC), cut-off value, sensitivity, specificity and accuracy were calculated. In addition, the T1WI and T2WI hyperintense and their types in the uterine wall were observed. Results There were significant differences in JZmax, JZdiff and JZmax/Mmax between the adenomyosis and control groups (all P<0.01). The AUC for the diagnosis of adenomyosis by JZmax JZdiff, and JZmax/Mmax were 0.95, 0.90, and 0.85, respectively. When JZmax≥10 mm, the sensitivity, specificity and accuracy were 78.8%, 97.3% and 88.6%, respectively; when JZdiff≥3.4 mm, those were 81.8%, 91.9% and 87.1%, respectively; When JZmax/Mmax≥61%, those were 72.7%, 83.8% and 78.6%, respectively. Eighteen cases (48.6%) had only T2WI hyperintense, while 14 cases (37.8%) had both T1WI and T2WI hyperintense; most of them showed snowdrift sign on T1WI and (or) T2WI. T1WI and (or) T2WI showed linear stripe sign in 5 cases (13.5%), microcapsule sign in 5 cases (13.5%), and cystic hemorrhage syndrome in 1 case (2.7%). Conclusion JZmax≥10 mm, JZdiff≥3.4 mm and JZmax/Mmax≥61% have significant diagnostic value in diagnosis of adenomyosis, and JZmax has the best diagnostic efficiency. Snowdrift sign, linear stripe sign, microcapsule sign and cystic hemorrhage sign on T1WI and (or) T2WI are unique for the diagnosis of adenomyosis. Comprehensive evaluation of the above signs can improve the diagnostic value of MRI and early accurate diagnosis of adenomyosis.

Laparoscopic Surgery for Focal Adenomyosis.

BACKGROUND AND OBJECTIVES: For conservative surgical treatment of focal uterine adenomyosis, laparoscopic adenomyomectomy has been increasingly performed, so that reassessment to determine the safety and efficacy of the laparoscopic surgical technique in a larger number of cases and reevaluation for reproducibility for laparoscopic adenomyomectomy is needed. We evaluate the clinical outcomes of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) for focal uterine adenomyosis performed by a single surgeon at a single institute. METHODS: Patients (N = 105) with symptomatic focal uterine adenomyosis underwent laparoscopic adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital from May 1, 2011, through September 30, 2016. Surgical outcomes included operative time; intraoperative injury to blood vessels, nerves, and pelvic organs; and intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and relapsing or remnant adenomyosis lesion by ultrasonography at the 7-momth follow-up after the operation. Then, all patients were followed up at 6-month intervals at the outpatient clinic. RESULTS: The mean patient age was 41.98 ± 4.73 years. The mean TOUA and operative times were 4.46 ± 2.68 and 75.14 ± 20.56 min, respectively. The mean estimated blood loss was 148.19 ± 101.69 mL. No conversion to laparotomy or major complications occurred. At the 7-month follow-up, complete remission of dysmenorrhea and menorrhagia had occurred in 93.02% and 76.92% of patients, respectively. CONCLUSIONS: Laparoscopic adenomyomectomy with TOUA is a safe and effective surgical treatment modality for women with symptomatic focal uterine adenomyosis who want to preserve fertility.

Comparison of four establishment methods of nude mouse models of human-derived uterine adenomyosis / 中国实验动物学报

Objective The purpose of this study was to compare the adenomyosis models in nude mice generated by four different methods,and to find out an optimal modeling method, and to provide an ideal animal model for exploring pathogenesis and experimental treatment of uterine adenomyosis. Methods 1. 80 female healthy nude mouse were divided randomly into 4 groups: Intraperitoneal implantation group, subcutaneous implantation group, intraperitoneal injection group, and subcutaneous injection group. The transplants were taken for pathological examination at 4 weeks after surgery. Results The success rate of intraperitoneal implantation group was 95%,and that of the subcutaneous implantation group was 45%,while the success rate of intraperitoneal injection group and subcutaneous injection group was 0%. Conclusions Establishment of a nude mouse model of uterine adenomyosis by intraperitoneal implantation method has a high success rate and with good stability, and is an ideal mouse model of human-derived uterine adenomyosis.

The therapeutic effect of percutaneous microwave ablation in treatment of focal uterine adenomyosis / 中华医学超声杂志（电子版）

Objective To observe and analyze the therapeutic effect of focal uterine adenomyosis treated with percutaneous microwave ablation by contrast-enhanced ultrasound and dynamic contrast enhanced MRI (DCE-MRI).Methods From January 2013 to July 2016,42 patients with focal uterine adenomyosis voluntarily underwent percutaneous microwave ablation in the tumor hospital of Liaocheng.Contrast-enhanced ultrasound and DCE-MRI were performed before and after percutaneous microwave ablation.The therapeutic effects of percutaneous microwave ablation in treatment of uterine adenomyosis lesions were observed.Results After percutaneous microwave ablation of the 42 cases,the ablated zone showed no enhancement with contrast-enhanced ultrasound and DCE-MRI.Contrast-enhanced ultrasound showed that the volume and ablation rate of ablated zone were (49.0±29.5) cm3 and (91.6± 7.1)％,and that of DCE-MRI were (49.4 ± 29.9)cm3 and (91.9 ± 6.7)％,respectively.The results showed that percutaneous microwave ablation could cure focal uterine adenomyosis at the rate over 90％.Contrast-enhanced ultrasoundand DCE-MRI are in accordance in observing the ablation rate.Conclusions Contrast-enhanced ultrasound can accurately show the ablation rate of focal uterine adenomyosis treated with percutaneous microwave ablation,which is quite consistent with DCE-MRI.Contrast-enhanced ultrasound has its advantages such as identifying the lesions which need immiedately supplemental ablation.

Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis.

AIM: This study aimed to determine the feasibility and safety of adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic diffuse uterine adenomyosis. MATERIAL AND METHODS: Twenty-six patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury to blood vessels, nerves, and pelvic organs and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 4-month follow-up after completion of adjuvant gonadotrophin-releasing hormone agonist. RESULTS: The mean age of patients was 37.73 years (range, 27-49 years). The mean total surgical time was 95.0 min (range, 60-145 min; SD, 34.49). The mean estimated blood loss was 191.54 mL (range, 80-400 mL; SD, 110.91) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean time of TOUA was 9.79 min (range, 6-16 min; SD, 2.74). The mean duration of hospital stay was 5.65 days (range, 4-7 days; SD, 0.85). There were no major complications requiring reoperation or readministration during the mean follow-up period of 13.5 months. At the 7-month follow-up after adenomyomectomy with TOUA, complete remission of dysmenorrhea and menorrhagia was observed in 94.4% and 100% of patients, respectively. CONCLUSIONS: Adenomyomectomy with TOUA could be a safe and effective surgical method in women with symptomatic diffuse uterine adenomyosis to preserve fertility.