Medical treatment for adenomyosis and/or adenomyoma

Uterine adenomyosis and/or adenomyoma is characterized by the presence of heterotopic endometrial glands and stroma within the myometrium, >2.5 mm in depth in the myometrium or more than one microscopic field at 10 times magnification from the endometrium–myometrium junction, and a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravasated, hemolyzed red blood cells, and siderophages. Hysterectomy is a “gold standard” and definitive therapy for uterine adenomyosis, and many cases of adenomyosis have been diagnosed by pathological review retrospectively. As such, the diagnosis of adenomyosis is difficult, and this subsequently results in difficulty in the management of these patients, especially those who are symptomatic but have a strong desire to preserve their uterus. In our previous review, we found that the use of uterine-sparing surgery in the management of uterine adenomyosis and/or adenomyoma is still controversial, although some data support its feasibility. Conservative treatment is still needed in the group of patients that requires preservation of fertility and improvement of quality of life. However, studies focusing on the topic of medical treatment for adenomyosis are rare. In this article, current knowledge regarding the use of medical therapy for uterine adenomyosis, partly based on the understanding of endometriosis, is reviewed.     

Immunohistochemical study of mucin expression in periampullary adenomyoma

Background/purpose

Benign tumors and tumor-like conditions in the ampullary area are uncommon, and there are extremely rare cases of adenomyoma (AM) and adenomyomatous hyperplasia (AMH). Surgical treatment is necessary if these lesions cause biliary obstruction. In addition, the differential diagnosis of AM and AMH from carcinoma is often difficult by standard endoscopic biopsy and cytopathological analysis that may show differential findings, resulting in unnecessary surgeries sometimes being performed.

Methods

Immunohistochemical (IHC) analysis of periampullary AM and AMH was performed.

Results

For both types of lesions, epithelial glandular cells (EGCs) showed diffuse expression of MUC6 and focal expression of HIK1083, mainly in the inner region, and focal expression of MUC5AC, mainly at the surface. The EGCs showed no expression of MUC1 or MUC4, both of which were identified as malignant tumor markers in our previous series of mucin expression studies in pancreatobiliary tumors. The expression of CK7, which was diffusely positive in normal periampullary mucosa, was decreased in the EGCs of AM and AMH.

Conclusions

A combined evaluation of IHC findings may be effective in the detection of AM and AMH, and also in distinguishing benign periampullary lesions, such as AM and AMH, from ampulla of Vater adenocarcinoma, thus avoiding excessive surgery.     

内镜下子宫动脉阻断术在子宫腺肌症手术治疗中的应用价值

目的 探讨双侧子宫动脉阻断术在子宫腺肌症手术治疗中的临床疗效.方法 对24例要求保留子宫的子宫腺肌症患者,通过腹腔镜下行双侧子宫动脉阻断术,其中21例患者加异位病灶挖除术.术后观察月经症状、痛经程度的改变及子宫体积的变化.结果 治疗后随访24个月以上,月经症状缓解率100%;痛经症状缓解率83.3%(20/24);其中21例忠者术后1年痛经明显缓解,1例手术2年后复发;子宫体积平均缩小42.6%;5例患者出现偶发性下腹部疼痛,消炎痛栓对症治疗可获得缓解,无1例闭经,术后2年血性激素测定值与术前相似且在正常范围.结论 双侧子宫动脉阻断加病灶挖除术能明显改善痛经及月经症状,缩小子宫体积,疗效稳定,具有一定的实用价值.     

Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage

A case of single large cystic adenomyoma of the uterus (anechoic area 1.6 cm in diameter) was diagnosed by surgery and histopathologic analysis more than 3 years after a transcervical curettage for an early right-cornual pregnancy.     

经阴道超声诊断子宫肌瘤和子宫腺肌瘤临床分析

目的：探讨经阴道二维及彩色多普勒诊断子宫肌瘤、子宫腺肌瘤的临床价值。方法：对我院2009年7月—2011年7月经手术病理证实子宫肌瘤及子宫腺肌瘤127例,经阴道超声分析二维及彩色多普勒血流显像（CDFI）特征。结果：二维图像上均呈特征性改变;CDFI示子宫肌瘤周边血流丰富,动脉血流阻力指数RI为0.56±0.18,子宫腺肌瘤周边血流信号稀少,RI为0.76±0.06;经阴道超声诊断子宫肌瘤、腺肌瘤符合率分别为：95.8%、94.6%。结论：经阴道彩色多普勒超声为子宫肌瘤、子宫腺肌瘤的鉴别诊断提供有价值信息。     

彩色多普勒超声对87例子宫腺肌瘤的诊断分析

目的通过彩色多普勒超声检测诊断子宫腺肌瘤,为临床诊治提供可靠依据。方法对87例子宫腺肌瘤患者进行彩色多普勒检测,记录结果并做回顾性分析。结果本研究87例患者,诊断符合率为96．55％,误诊率为3．45％。腹部和阴道超声联合探查要优于单纯腹部或阴道超声检查。子宫腺肌瘤组的搏动指数（PI）显著高于正常对照组（P〈0．05）,而子宫动脉阻力指数（RI）、血流量（BFV）则出现显著下降。结论彩色多普勒超声是临床诊断子宫腺肌瘤的首选辅助检查,其诊断准确率高。     

腹腔镜下子宫腺肌瘤切除术合并阻断子宫动脉术的临床观察

目的观察腹腔镜下子宫腺肌瘤切除术和阻断子宫动脉术的临床效果。方法将2010年4月至2012年5月确诊的80例子宫腺肌瘤患者随机分为两组,治疗组（43例）应用腹腔镜超声辅助下阻断子宫动脉后行子宫腺肌瘤切除术治疗,对照组（37例）应用腹腔镜超声辅助下行子宫腺肌瘤切除术治疗,观察两组患者的术中出血量、手术时间、住院天数、术后病率、并发症及术后复发率。结果治疗组患者术中出血量明显小于对照组（P〈0．05）;治疗组患者手术时间明显大于对照组（P〈0．05）;两组患者的住院天数、术后病率及并发症差异无统计学意义（P〉0．05）。治疗组患者术后复发率明显小于对照组（P〈0．05）。结论腹腔镜辅助下子宫腺肌瘤切除术合并阻断子宫动脉术的止血效果良好,有效控制术中出血量,显著地降低术后复发率。此法可靠性强,操作性良好,具有较好临床应用价值。     

Ovarían Ligament Adenomyoma: A Case Report

Background: Adenomyoma is a benign tumour composed of smooth muscle and benign endometrium. These tumours typically originate within the uterus. An extra-uterine adenomyoma is a rare entity.

Case: We report a case of extra-uterine adenomyoma of the ovarian ligament, which was an incidental finding during a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a benign ovarian tumour in a postmenopausal woman. The mass was round with uterine-type smooth muscle and scattered functional endometrial glands and stroma. Discussion: Only seven other cases of an extra-uterine uterine-like mass are reported in the literature. There have been no cases of adenomyoma in the ovarian ligament reported until now.

Conclusion: It is most likely that this uterine-like mass arose from the tissues of the secondary müllerian system.