不同亚型子宫腺肌病的临床病理特征：关注早期病变。
Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions.
机构信息
Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan.
Ms. Clinic MayOne, Kashihara, Nara, Japan.
出版信息
PLoS One. 2021 Jul 14;16(7):e0254147. doi: 10.1371/journal.pone.0254147. eCollection 2021.
BACKGROUND
The aim of this study is to investigate the clinicopathological features of intrinsic and extrinsic subtypes in adenomyosis. In particular, we focused on the early lesions of adenomyosis.
METHODS
This is a single-center, prospective study of women who elected surgery for adenomyosis at the Department of Gynecology, Nara Medical University Hospital, Kashihara, Japan, from April 2008 to March 2018. Adenomyosis was histologically classified as intrinsic, extrinsic, and others, depending on the type of intramural growth. Adenomyosis that occurs at the inner and outer myometrium was defined as an intrinsic and extrinsic type, respectively.
RESULTS
One hundred eighty-nine patients with histologically confirmed adenomyosis were classified into three different types, 74 intrinsic type, 78 extrinsic type, and 37 other type. Compared to the intrinsic type, the extrinsic type was more likely to have endometriosis, including ovarian endometrioma (OMA), superficial peritoneal endometriosis (SUP), or deep infiltrating endometriosis (DIE). To further identify the clinicopathological features of early-stage adenomyosis, we focused only on patients with intrinsic and extrinsic types of adenomyosis with less than one-third of muscular layer infiltration. Patients with early-stage intrinsic adenomyosis were more likely to experience induced abortions. Patients with early-stage extrinsic adenomyosis were more likely to have endometriosis. The coexistence of endometriosis and the lack of induced abortion were independent predictors of extrinsic adenomyosis. Multivariate logistic regression analysis identified coexistence of endometriosis as independent predictors of the early stage extrinsic adenomyosis.
CONCLUSION
The study suggests that there are at least two types of adenomyosis, where the intrinsic type is closely associated with a history of induced abortion, while the extrinsic type is strongly associated with endometriosis. Adenomyosis might be a gynecological disorder with complex pathogenesis implicating both traumatic and endometriotic factors.
背景
本研究旨在探讨子宫腺肌病的内在和外在亚型的临床病理特征。特别是，我们关注的是子宫腺肌病的早期病变。
方法
这是一项单中心、前瞻性研究，纳入了 2008 年 4 月至 2018 年 3 月期间在日本奈良医科大学医院妇产科因子宫腺肌病接受手术的女性患者。根据子宫壁内生长的类型，将子宫腺肌病组织学分为内在型、外在型和其他类型。发生在内、外子宫肌层的子宫腺肌病分别定义为内在型和外在型。
结果
189 例经组织学证实的子宫腺肌病患者被分为 3 种不同类型，其中 74 例为内在型，78 例为外在型，37 例为其他类型。与内在型相比，外在型更有可能患有子宫内膜异位症，包括卵巢子宫内膜瘤（OMA）、浅表腹膜子宫内膜异位症（SUP）或深部浸润性子宫内膜异位症（DIE）。为了进一步明确早期子宫腺肌病的临床病理特征，我们仅关注内在型和外在型子宫腺肌病中肌层浸润不到三分之一的患者。早期内在型子宫腺肌病患者更有可能经历人工流产。早期外在型子宫腺肌病患者更有可能患有子宫内膜异位症。子宫内膜异位症的共存和人工流产的缺乏是外在型子宫腺肌病的独立预测因素。多变量逻辑回归分析确定子宫内膜异位症的共存是早期外在型子宫腺肌病的独立预测因素。
结论
该研究表明，至少存在两种类型的子宫腺肌病，内在型与人工流产史密切相关，而外在型与子宫内膜异位症密切相关。子宫腺肌病可能是一种涉及外伤性和子宫内膜异位性因素的复杂发病机制的妇科疾病。
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