Selntigia Aikaterini, Molinaro Pietro, Tartaglia Silvio, Pellicer Antonio, Galliano Daniela, Cozzolino Mauro
IVIRMA Global Research Alliance, IVIRMA Roma, 00169 Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy.
J Clin Med. 2024 Sep 3;13(17):5224. doi: 10.3390/jcm13175224.
This review article aims to summarize current tools used in the diagnosis of adenomyosis with relative pharmacological and surgical treatment and to clarify the relative association between adenomyosis and infertility, considering the importance of an accurate diagnosis of this heterogeneous disease. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into the myometrium is the most widely accepted opinion on the development of adenomyosis. Adenomyosis has been increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging points of view, and diagnosis remains difficult and unclear. A standard, universally accepted classification system needs to be implemented to improve our understanding and inform precise diagnosis of the type of adenomyosis. This could be the key to designing RCT studies and evaluating the impact of adenomyosis on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome, given the high risk of miscarriage and obstetric complications.
这篇综述文章旨在总结目前用于诊断子宫腺肌病的工具以及相关的药物和手术治疗方法，并阐明子宫腺肌病与不孕症之间的相对关联，同时考虑到准确诊断这种异质性疾病的重要性。在不同报道的概念中，腺上皮细胞从子宫内膜基底层向肌层深部的方向内陷是关于子宫腺肌病发病机制最被广泛接受的观点。通过经阴道超声和磁共振成像等技术，子宫腺肌病在有疼痛、异常子宫出血、不孕或无症状的年轻女性中越来越多地被发现。此外，子宫腺肌病常与其他妇科疾病共存，如子宫内膜异位症和子宫肌瘤，这增加了现有数据的异质性。然而，从组织病理学和影像学角度来看，对于子宫腺肌病病变的定义和分类尚无共识，诊断仍然困难且不明确。需要实施一个标准的、被普遍接受的分类系统，以增进我们的理解，并为子宫腺肌病类型的精确诊断提供依据。鉴于流产和产科并发症的高风险，这可能是设计随机对照试验研究以及评估子宫腺肌病对月经症状、生育能力和妊娠结局方面生活质量影响的关键。
