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A - MSRA Gynaecology [8] > [36] Adenomyosis > Flashcards

[36] Adenomyosis Flashcards

1
Q

What is adenomyosis?

A

The presence of functional endometrial tissue within the myometrium of the uterrus

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2
Q

Which layer of the uterine wall is invaded by endometrium in adenomyosis?

A

Middle layer

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3
Q

What is the relationships between adenomyosis and endometriosis?

A

Adenomyosis has been described as a variant of endometriosis, but although the conditions can occur together, they are distinct diagnoses

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4
Q

How common is adenomyosis in hysterectomy specimens?

A

It is found in up to 40% of hysterectomy specimens

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5
Q

What is the pathophysiology of adenomyosis?

A

It is thought to occur when the endometrial stroma is allowed to communicate with the underlying myometrium after uterine damage

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6
Q

What is the endometrial stroma?

A

Connective/supporting tissue

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7
Q

What might cause interaction between the underlying myometrium and the endometrial stroma?

A
  • Pregnancy and childbirth
  • C-section
  • Uterine surgery
  • Surgical management of miscarriage or termination of pregnancy
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8
Q

Give an example of a uterine surgery that might allow the interaction of myometrium and endometrial stroma

A

Endometrial curettage

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9
Q

Is the invasion of endometrium focal or diffusion in adenomyosis?

A

Can be either

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10
Q

Where is invasion of endometrium in adenomyosis most commonly found?

A

In the posterior wall of the uterus

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11
Q

How extensive is the invasion of endometrium in adenomyosis?

A

Variable

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12
Q

What can happen in severe cases of adenomyosis?

A

Pockets of menstrual blood can be seen in the myometrium of the hysterectomy specimens

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13
Q

What is an adenomyoma?

A

When a collection of endometrial glands form grossly visible nodules

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14
Q

What receptors are found in the ectopic endometrial tissue in adenomyosis?

A

Oestrogen, progesterone, and androgen receptors

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15
Q

What is the result of oestrogen, progesterone, and androgen receptors being found in the endometrial tissue in adenomyosis?

A

Makes it responsive to hormones

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16
Q

What are the risk factors for adenomyosis?

A
  • High parity
  • Uterine surgery
  • Previous C-section
  • Family history
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17
Q

Give 2 examples of uterine surgery that increase the risk of adenomyosis

A
  • Endometrial curettage

- Endometrial ablation

18
Q

What are the main presenting symptoms of adenomyosis?

A
  • Menorrhagia
  • Dysmenorrhoea
  • Deep dyspareunia
  • Irregular bleeding
19
Q

Describe the dysmenorrhoea in adenomyosis

A

It is commonly progressive, beginning as cyclical pain but can worsen to daily pain

20
Q

What may be found on examination in adenomyosis?

A

Symmetrically enlarged tender uterus

21
Q

What are the differential diagnoses for adenomyosis?

A
  • Endometriosis
  • Fibroids
  • Endometrial hyperplasia/endometrial carcinoma
  • Endometrial polyps
  • Pelvic inflammatory disease
  • Hypothyroidism and coagulation disorders
22
Q

How is the definitive diagnosis of adenomyosis made?

A

Histological diagnosis after hysterectomy

23
Q

What recent advances have there been in the diagnosis of adenomyosis?

A

Advances in histological diagnosis from specimens obtained at hysteroscopic biopsy

24
Q

What can assist the diagnosis of adenomyosis in clinically suspected cases?

A

Imaging

25
Q

What imaging is used in adenomyosis?

A
  • Transvaginal ultrasound

- MRI

26
Q

What is the limitation of transvaginal ultrasound in adenomyosis?

A

Highly observer dependant

27
Q

What are the signs of adenomyosis on transvaginal ultrasound?

A
  • Globular uterine configuration
  • Poor definition of the endometrial-myometrial interface
  • Myometrial anterior-posterior asymmetry
  • Intramyometrial cysts
  • Heterogenous myometrial echo texture
28
Q

What does MRI show in adenomyosis?

A

‘Endo-myometrial junctional zone’ that can be distinguished from the endometrium and outer myometrium

29
Q

What is recognised as a hallmark of adenomyosis on MRI?

A

Irregular thickening of the endometrial junction

30
Q

What is the main aim of the management of adenomyosis?

A

Control dysmenorrhoea and menorrhagia

31
Q

What is the only curative therapy for adenomyosis at present?

A

Hysterectomy

32
Q

What are the more conservative approaches aimed at symptom control in adenomyosis?

A
  • Analgesia
  • Hormone therapy
  • Non-hormone treatments
33
Q

What analgesics are used in adenomyosis?

A

NSAIDs

34
Q

What hormone therapies are available for the management of adenomyosis?

A
  • Combined oral contraceptives
  • Progestogens
  • Gonadotrophin releasing hormone agonists
  • Aromatase inhibitors
35
Q

How can progesterones be administered in adenomyosis?

A
  • Oral

- intrauterine system. e.g. Mirena

36
Q

What is the purpose of hormonal therapy in adenomyosis?

A

Reduction of bleeding and cycle control

37
Q

How do hormonal therapies work in adenomyosis?

A

Proposed that hormones reduce the proliferation of the ectopic endometrial cells, therefore reducing their mass and subsequently decreasing uterine size and volume of blood lost

38
Q

What can temporarily induce the regression of adenomyosis?

A

Continuous combined oral contraceptive and high dose progestins, e.g. SC depot medroxyprogesterone

39
Q

What are the non-hormonal treatments available in adenomyosis?

A
  • Hysterectomy
  • Uterine artery embolism
  • Endometrial ablation and resection
  • Laparoscopic excision
  • MR-guided focused ultrasound
40
Q

Is uterine embolism a long or short term management option for adenomyosis?

A

Short and medium

41
Q

Who is uterine artery embolism a good option for in adenomyosis?

A

Women who wish to avoid hysterectomy and/or preserve their fertility

42
Q

What is the aim of uterine artery embolism in adenomyosis?

A

Block blood supply to the adenomyosis, causing it to shrink

A - MSRA Gynaecology [8] (52 decks)

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