Department of Surgical Sciences, Gynecologic Unit, University of Rome "Tor Vergata" (Drs. Exacoustos, Martire, Russo, and Piccione), Rome.
Department of Molecular and Developmental Medicine, University of Siena, Siena, (Drs. Lazzeri, Martone, Centini, and Zupi), Italy.
J Minim Invasive Gynecol. 2022 Feb;29(2):291-299.e1. doi: 10.1016/j.jmig.2021.08.023. Epub 2021 Aug 28.
To evaluate the ultrasound features, types, and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptoms DESIGN: A retrospective observational study.
Gynecological ultrasound units from January 2014 to June 2020.
A total of 43 adolescents (aged 12-20 years) who were diagnosed as having adenomyosis at a pelvic ultrasound examination.
Ultrasound features and location and type of adenomyosis within the uterus were evaluated on stored 2-dimensional images and videos and 3-dimensional volumes. Adenomyosis was classified as mild, moderate, and severe according to the extension of the disease in the uterus as described in our previous published classification.
Adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas, and some types of junctional zone alterations. The posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% of adolescents (19/43) with adenomyosis, at least 1 location of pelvic endometriosis was documented. Dysmenorrhea was the most commonly reported symptoms (88%), and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry, and intramyometrial cystic areas. Adolescents with dyspareunia showed diffuse adenomyosis (9/9 patients) including both the inner and outer myometrium (7/9 patients) and in the posterior wall (7/9 patients). Heavy menstrual bleeding was associated with diffuse adenomyosis (18/23 patients) mostly of the outer myometrium (22/23 patients). Scoring system showed predominantly mild disease and no severe adenomyosis was found. Adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding compared with those with the focal disease of the inner myometrium.
This study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild-to-moderate form and is associated with typical painful symptoms. In adolescents, the diagnosis of adenomyosis is feasible through a noninvasive way with ultrasound and a proper management can be set.
评估青少年腺肌病的超声特征、类型和程度，并将这些发现与临床症状相关联。
回顾性观察性研究。
2014 年 1 月至 2020 年 6 月妇科超声室。
共 43 名（年龄 12-20 岁）在盆腔超声检查中被诊断为腺肌病的青少年。
评估存储的二维图像、视频和三维容积中子宫内腺肌病的超声特征、位置和类型。根据我们之前发表的分类，根据疾病在子宫内的扩展程度，将腺肌病分为轻度、中度和重度。
在我们的人群中记录到的腺肌病特征是子宫肌层高回声区、子宫壁不对称、子宫内囊性区和一些类型的交界区改变。后子宫壁（58%）和外子宫肌层（93%）最常受累。在 44%（19/43）有腺肌病的青少年中，至少有 1 个部位记录到盆腔子宫内膜异位症。痛经是最常见的症状（88%），与外子宫肌层、子宫肌层高回声区、子宫壁不对称和子宫内囊性区相关。性交困难的青少年表现为弥漫性腺肌病（9/9 例患者），包括内、外子宫肌层（7/9 例患者）和后壁（7/9 例患者）。月经过多与弥漫性腺肌病相关（23/23 例患者），主要在外子宫肌层（23/23 例患者）。评分系统显示主要为轻度疾病，没有发现严重的腺肌病。弥漫性腺肌病的青少年明显年龄较大，与内子宫肌层局灶性疾病患者相比，月经过多的发生率较高。
本研究表明，腺肌病不仅是成人生活的一种病理，而且还涉及年轻患者，主要为轻度至中度，并与典型的疼痛症状相关。在青少年中，通过超声可以无创地诊断腺肌病，并可以制定适当的治疗方案。
