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Adenomyomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Anshumala Shukla Kulkarni, Fouzia Hayat
Adenomyomectomy should not be the be-all and end-all in managing adenomyomas. Prior to making a decision to undertake operative adenomyomectomy, one should consider whether conservative medical treatment may alleviate the patient’s symptoms without subjecting her to the risks of surgery. In cases where adenomyomectomy has been deemed to be the best management option, consideration should be given to the use of adjuvant medical therapy postoperatively to improve patient outcomes. A variation of adenomyoma can be seen as multiple cystic adenomas. This is a rare form of adenomyoma. It presents as multiple cystic spaces in myometrium usually subserosal and contains endometrial tissue. These cystic spaces are actually cavitated lesions usually more than a cm and contain chocolate fluid. (Figures 18.9–18.12).
Ultrasound assessment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Images 6a and 6b are parasagittal sections of the uterus showing textural irregularities and significantly increased thickening of the posterior wall of a retroverted uterus. Localised vascular changes were demonstrated by CDI, shown in Image 6c. G-S and CDI appearances are consistent with adenomyosis. An adenomyoma (A) is noted within the posterior uterine wall. It should be noted that a very high proportion of patients with endometriosis present with a retroverted uterus! Images 6d and 6e show typical multifollicular change and increased stromal development in both ovaries. Image 6f confirms the presence of a very active corpus luteum on the left ovary as confirmed by CDI. TVS–CDI assessment of the rectovaginal septum confirms an abnormal increase in tissue vascularity within that area in Image 6g. 3D TUI parasagittal sections in Image 6h show a clear demarcation and separation between the vagina (V) and rectum (R) towards one side. The interface is lost and obvious adhesions involving the vaginal and rectal walls can be visualised in image slices within the mid-line region and moving towards the opposite side. The combination of high-resolution 3D TVS imaging and CDI confirms extensive rectovaginal adhesions associated with pelvic endometriosis and likely endometriosis associated with the rectovaginal region.
Natural history: Basics of endometriosis
Published in Seema Chopra, Endometriosis, 2020
With ongoing research, Sampson, in 1925 [26], postulated that endometrial tissue that sloughs into uterine veins, the theory of retrograde menstruation, could be the cause of adenomyosis and spread of disease beyond the pelvis in menstruating women. In an attempt to redefine the terminology, Sampson first introduced the term “endometriosis” interchangeably with the term “implantation adenomyoma.” It was the exact description of the anatomical picture for the mucosal invasion of the myometrium by the endometrial glands by Frankl [18] as “adenomyosis uteri.” He also enumerated the criteria to differentiate it from endometriosis, stating, “In an adenomyoma the glands originate independently within the myoma as an autochthonous (indigenous) growth, while in adenomyosis, even when localized, the direct connection of the endometrium with the islands of mucosa located in the musculature can be established in serial sections. In the majority of cases of genuine adenomyoma, which are extremely rare, the glands are not accompanied by stroma.” Thus, at this point, “adenomyoma” was subdivided into two separate entities, endometriosis and adenomyosis.
Cardiometabolic profiles in women with adenomyosis
Published in Journal of Obstetrics and Gynaecology, 2022
Seda Ates, Serdar Aydın, Pinar Ozcan
The two-dimensional TVS (2D-TVS) (Voluson E6; GE Medical Systems, Milwaukee, WI) was performed with a 7.5-MHz probe by a single experienced gynaecologist (S.A.). Uterine volume was calculated using the prolate ellipsoid formula (Platt et al. 1990). Colour Doppler was used to distinguish myometrial cysts from large blood vessels and differentiate leiomyomas from focal adenomyosis. The diagnosis of adenomyosis was based on the presence of two or more criteria including asymmetrical myometrial thickening, heterogeneous myometrium, myometrial cysts, subendometrial echogenic linear striations and buds, parallel shadowing, interruption or irregularities of the junctional zone (JZ), adenomyoma and question mark sign (Kepkep et al. 2007; Naftalin et al. 2012; Andres et al. 2018; Zannoni et al. 2020). The diagnosis was also confirmed histopathologically in 13 patients who underwent hysterectomy for several reasons (e.g. abnormal uterine bleeding), in one patient who underwent adenomyomectomy, and based on hysteroscopic reports in two patients. Diagnosis of endometriosis was made if ovarian endometriomas or endometriotic nodules were visualised at TVS.
A comparison of reproductive outcomes of patients with adenomyosis and infertility treated with High-Intensity focused ultrasound and laparoscopic excision
Published in International Journal of Hyperthermia, 2020
Yu Fu Huang, Jia Deng, Xue Li Wei, Xin Sun, Min Xue, Xiao Gang Zhu, Xin Liang Deng
Under general anesthesia, patients were placed in a dorsal lithotomy position, sterilized, and draped with a towel. An arc-shaped incision was then made at the upper edge of the umbilicus to create a pneumoperitoneum, and the abdominal pressure was set to 12 mmHg. Trocars were used to puncture the abdomen and they were placed under the microscope to prevent the vessel from getting into the lower abdominal wall. Uterine body injection of oxytocin (20 µnits) was administered under a laparoscope, and an electrocoagulation hook was used to make a longitudinal incision into the sarcomuscular layer to reach the tumor. The adenomyoma surface was bluntly separated. The adenomyoma was removed, and the sarcomuscular layer was continuously sutured. Normal saline was used for flushing the pelvic cavity. After cessation of active bleeding was detected, the instrument was pulled out and gas was released.
Simultaneously occurring disseminated peritoneal leiomyomatosis and multiple extrauterine adenomyomas following hysterectomy
Published in Baylor University Medical Center Proceedings, 2019
Jessica A. Belmarez, Hamid R. Latifi, Wei Zhang, Carolyn M. Matthews
Though uterine leiomyomas and adenomyomas are relatively common benign tumors, the appearance of these tumors in extrauterine locations is exceedingly rare. The pathogenesis behind extrauterine proliferation of leiomyomas and adenomyomas is not well understood, in part because of the rarity of the conditions. The most widely reported theory is that of parasitic spread of the tumors after seeding during hysterectomy or myomectomy.3 In particular, multiple cases of DPL have been reported following morcellated hysterectomy/myomectomy—a laparoscopic procedure in which the myometrial tissue is divided into multiple small fragments in situ using a power morcellator prior to extraction.3–5 This is due to the fact that morcellation carries the risk of leaving small fragments of fibroid or even unsuspected malignant tumor behind, thereby seeding the pelvis and laying the groundwork for tumor proliferation. In April 2014, the US Food and Drug Administration recommended that manufacturers of laparoscopic power morcellators include a warning label on the devices to inform patients and surgeons of the risk of potential abdominopelvic seeding of occult uterine cancer with morcellation procedures.6,7 Of note, however, not all patients with extrauterine leiomyomas or adenomyomas have a history of their intrauterine counterparts. In our patient, there was a history of uterine fibroids but not of adenomyoma or adenomyosis.