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Adenomyosis

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101. Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction Full Text available with Trip Pro

Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual

2018 Obstetrics & gynecology science

102. Coexistence of adenomyosis, adenocarcinoma, endometrial and myometrial lesions in resected uterine specimens Full Text available with Trip Pro

Coexistence of adenomyosis, adenocarcinoma, endometrial and myometrial lesions in resected uterine specimens The present study was conducted to identify endometrial and myometrial lesions coexisting with adenomyosis, and to evaluate the clinicopathological characteristics of endometrial adenocarcinomas associated with adenomyosis. A retrospective analysis of the resected uterine specimens of 319 patients with adenomyosis admitted between January 1, 2014 and August 1, 2017 was performed (...) . The endometrial and myometrial lesions coexisting with adenomyosis were evaluated. The clinicopathological prognostic factors, including tumor grade, myometrial invasion, lymphovascular space involvement, lymph node invasion, pathological stage and recurrence, were analysed. For data analysis, the Chi-squared test was used and a P-value of <0.05 was considered to indicate statistically significant differences. The mean age of the patients was 52.1 years. A total of 32 patients had endometrial carcinoma

2018 Molecular and clinical oncology

103. Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy in a Woman with Uterine Adenomyosis and Multiple Severe Abdominal Adhesions Full Text available with Trip Pro

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy in a Woman with Uterine Adenomyosis and Multiple Severe Abdominal Adhesions Natural orifice transluminal endoscopic surgery (NOTES) had been used for many gynecologic surgeries without pelvic adhesions. We report a 30-year-old female with multiple abdominal adhesions underwent NOTES hysterectomy successfully. A 30-year-old female (para 2, gravida 3, abortus 1) presented with menorrhagia and dysmenorrhea. She had multiple (...) abdominal surgical histories. Computed tomography scan revealed multiple adhesions between the abdominal wall and small intestine. On pelvic ultrasonography, an enlarged uterus 8.3 cm × 3.5 cm with adenomyosis was visualized. Because of the extensive intra-abdominal adhesions, we decided to use a transvaginal NOTES approach to perform hysterectomy. We performed the surgery successfully without complication. Pathological examination confirmed adenomyosis of uterus. NOTES hysterectomy may be feasibly

2018 Gynecology and Minimally Invasive Therapy

104. Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Adenomyosis: Protocol for the Randomized QUESTA Trial Full Text available with Trip Pro

Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Adenomyosis: Protocol for the Randomized QUESTA Trial Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce (...) )-confirmed pure adenomyosis or dominant adenomyosis accompanied by fibroids. After obtaining informed consent, patients will be randomly allocated to treatment in a 2:1 UAE versus hysterectomy ratio. The primary objective is HRQOL at 6 months following the assigned intervention. Secondary outcomes are technical results, pain management, clinical outcomes, HRQOL, and cost effectiveness during 2 years of follow-up. In addition, transvaginal ultrasound (TVUS) and MRI will be performed at regular intervals

2018 JMIR Research Protocols Controlled trial quality: predicted high

105. Drug therapy for adenomyosis: a prospective, nonrandomized, parallel-controlled study Full Text available with Trip Pro

Drug therapy for adenomyosis: a prospective, nonrandomized, parallel-controlled study Objective To provide novel insights into the clinical treatment of adenomyosis. Methods Two hundred patients with adenomyosis were enrolled in this prospective, nonrandomized, parallel-controlled study with a 1-year follow-up in our hospital. Group 1 was treated with 3.75 mg leuprorelin acetate (LA) (n = 40), Group 2 was treated with 1.88 mg LA (n = 40), Group 3 underwent Mirena implantation (n = 40), Group 4 (...) and sweating. The 1-year Mirena expulsion rate was higher in Group 3 than in Groups 4 and 5 (10.00% vs. 3.33%, respectively). Costs were significantly higher in Groups 1 and 4 than in Groups 2 and 5. Conclusion Administration of 1.88 mg LA may be an alternative therapy for Asian patients with adenomyosis. The combination of LA and Mirena could enhance the therapeutic effect. Registration number: ChiCTR-IPR-15005971.

2018 The Journal of international medical research

106. GnRH agonist improves pregnancy outcome in mice with induced adenomyosis by restoring endometrial receptivity Full Text available with Trip Pro

GnRH agonist improves pregnancy outcome in mice with induced adenomyosis by restoring endometrial receptivity Adenomyosis has a negative impact on female fertility. GnRH agonist treatment can improve pregnancy outcomes in women with adenomyosis. However, the impact of GnRH agonist upon endometrium receptivity of patients with adenomyosis remains unclear. In this study, endometrial receptivity and pregnancy outcome were investigated using a mouse model of adenomyosis.Adenomyosis was induced (...) , Hoxa11, Lif and integrin b3 mRNA and protein were decreased in the adenomyosis group, and were significantly increased after GnRH agonist treatment. Additionally, pinopodes were reduced in number and poorly developed in mice with induced adenomyosis. However, pinopodes were abundant and well-developed in the GnRH agonist treatment group.Adenomyosis may have an adverse impact on endometrial receptivity and reduce pregnancy outcomes in mice. However, GnRH agonist may improve the pregnancy outcome

2018 Drug design, development and therapy

107. Endophytic-Type Endometrial Cancer with Adenomyosis Successfully Diagnosed with Hysteroscopic Endometrial Biopsy Using an 8.3-mm Operative Resectoscope: A Case Report Full Text available with Trip Pro

Endophytic-Type Endometrial Cancer with Adenomyosis Successfully Diagnosed with Hysteroscopic Endometrial Biopsy Using an 8.3-mm Operative Resectoscope: A Case Report In order to diagnose endometrial cancer preoperatively, outpatient endometrial biopsy with a curette is frequently performed owing to its convenience. However, in some cases, gynecologists fail to diagnose endometrial cancer via outpatient endometrial biopsy because of the cancer's distribution in the uterus and its consistency (...) . A 57-year-old Japanese woman (gravida 4 para 4) presented with a 6-month history of light but intermittent postmenopausal vaginal bleeding. A malignant uterine tumor was strongly suspected after imaging using ultrasound examination and magnetic resonance imaging; however, a precise pathological diagnosis was not achieved despite multiple outpatient endometrial biopsies with the aid of office hysteroscopy. Based on an endometrial biopsy obtained using a cutting loop electrode on an 8.3-mm operative

2018 Case reports in oncology

108. Abnormal expression of Nrf2 may play an important role in the pathogenesis and development of adenomyosis. Full Text available with Trip Pro

Abnormal expression of Nrf2 may play an important role in the pathogenesis and development of adenomyosis. To explore the expression level of Nrf2 in adenomyosis and study the mechanism of abnormal expression of Nrf2 in the pathogenesis of adenomyosis.Western blot, immunohistochemistry(IHC) and real time PCR were used to measure Nrf2 expression levels in tissue and cell samples. Knockdown and overexpression of Nrf2 were used to investigate the variation of migration ability of endometrial (...) glandular cells as well as the regulatory mechanism.Nrf2 protein levels were significantly higher in the eutopic and ectopic endometrial glands when compared with control cases using IHC and western blot methods. (p< 0.05). However, there was no statistical difference in Nrf2 mRNA expression levels between the adenomyosis and control groups. Using an agonist and Nrf2 siRNA, we regulated the Nrf2 protein levels of primary cultured endometrial glandular cells. With increased expression of Nrf2, cell

2017 PLoS ONE

109. Pathogenesis of uterine adenomyosis: invagination or metaplasia? (Abstract)

. Two main theories have been proposed to explain the origin of adenomyosis. The most common suggests involvement of tissue injury and the repair mechanism and claims that adenomyosis results from invagination of the endometrial basalis into the myometrium. An alternative theory maintains that adenomyotic lesions result from metaplasia of displaced embryonic pluripotent Müllerian remnants or differentiation of adult stem cells. Previous investigations performed in human adenomyotic lesions (...) Pathogenesis of uterine adenomyosis: invagination or metaplasia? Adenomyosis is a commonly diagnosed estrogen-dependent gynecological disorder that causes pelvic pain, abnormal uterine bleeding, and infertility. Despite its prevalence and severity of symptoms, its pathogenesis and etiology have not yet been elucidated. The aim of this manuscript is to review the different hypotheses on the origin of adenomyotic lesions and the mechanisms involved in the evolution and progression of the disease

2018 Fertility and Sterility

110. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Full Text available with Trip Pro

Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show (...) a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use

2018 Fertility and Sterility

111. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Full Text available with Trip Pro

Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. The aim of the present review, conducted according to PRISMA statement recommendations, was to evaluate the contribution of transvaginal sonography (TVS) and magnetic resonance imaging (MRI) to diagnose adenomyosis. Although there is a lack of consensus on adenomyosis classification, three subtypes are described, internal, external adenomyosis, and adenomyomas. Using TVS, whatever the subtype (...) , pooled sensitivities, pooled specificities, and pooled positive likelihood ratios are 0.72-0.82, 0.85-0.81, and 4.67-3.7, respectively, but with a high heterogeneity between the studies. MRI has a pooled sensitivity of 0.77, specificity of 0.89, positive likelihood ratio of 6.5, and negative likelihood ratio of 0.2 for all subtypes. Our results suggest that MRI is more useful than TVS in the diagnosis of adenomyosis. Further studies are required to determine the performance of direct signs (cystic

2018 Fertility and Sterility

112. Role of medical therapy in the management of uterine adenomyosis. Full Text available with Trip Pro

Role of medical therapy in the management of uterine adenomyosis. Adenomyosis is a benign uterine condition affecting women at various ages with different symptoms. The management of these patients is still controversial. Few clinical studies focusing on medical or surgical treatment for adenomyosis have been performed. No drug is currently labelled for adenomyosis and there are no specific guidelines to follow for the best management. Anyhow, medical treatments are effective in improving (...) symptoms (pain, abnormal uterine bleeding and infertility). The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis: sex steroid hormones aberrations, impaired apoptosis, and increased inflammation. Several nonhormonal (i.e., nonsteroidal anti-inflammatory drugs) and hormonal treatments (i.e., progestins, oral contraceptives, gonadotropin-releasing hormone analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding

2018 Fertility and Sterility

113. Uterine adenomyosis and adenomyoma: the surgical approach. Full Text available with Trip Pro

Uterine adenomyosis and adenomyoma: the surgical approach. The appropriate surgical treatment of adenomyosis, a benign invasion/infiltration of endometrial glands within the underlying myometrium, remains a subject of discussion. Since 1990, in place of the classical V-shaped resection method, various kinds of surgical management have been attempted, including a uterine muscle flap method that emphasizes fertility preservation, an asymmetric dissection method, and various modified reduction (...) methods. Laparoscopic adenomyomectomy has also become an alternative to laparotomy for surgically managing the focal type of adenomyosis, although it seems to be associated with a higher risk of uterine rupture than laparotomy. This article reviews the surgical treatment of adenomyosis, including 23 uterine rupture cases that occurred during post-adenomyomectomy pregnancies, and provides an updated picture of the state of the field.Copyright © 2018 The Author. Published by Elsevier Inc. All rights

2018 Fertility and Sterility

114. Minimally invasive treatment of adenomyosis. (Abstract)

Minimally invasive treatment of adenomyosis. The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD). A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine

2018 Best practice & research. Clinical obstetrics & gynaecology

115. Phenotypic characterization of adenomyosis occurring at the inner and outer myometrium. Full Text available with Trip Pro

Phenotypic characterization of adenomyosis occurring at the inner and outer myometrium. To estimate the phenotypic characterization of fibrotic process in adenomyosis occurring at the inner or the outer myometrium.Eight cases of adenomyosis occurring at the inner myometrium (Subtype I) and 10 cases of adenomyosis occurring at the outer myometrium (Subtype II), and 10 normal counterparts were used in this study. A immunohistochemical study for smooth muscle cells (SMCs) was performed using (...) cytoskeletal proteins, Type I and III collagen, TGF-β and its signaling molecules.An increased expression of Type I collagen was observed in the extracellular matrix of adenomyotic foci. In normal uteri, immunostaining of SMC differentiation marker proteins (Desmin, Smoothelin, Myosin heavy chain (MHC)) were absent or only found in low numbers at the inner myometrium, while all of these marker proteins were clearly stained at the outer myometrium. In both types of adenomyotic foci, Desmin, Smoothelin

2017 PLoS ONE

116. A sonographic classification and reporting system for diagnosing adenomyosis. Full Text available with Trip Pro

A sonographic classification and reporting system for diagnosing adenomyosis. To develop a uniform classification and standardized reporting system of ultrasound findings of adenomyosis using the Morphological Uterus Sonographic Assessment (MUSA) criteria.The opinion presented in this manuscript was built based on a thorough discussion among all authors, including a Delphi procedure. Selected images and videos of typical cases of the different morphological variations of adenomyosis were used (...) in the debates.A classification and reporting system of different types of adenomyosis based on ultrasound was agreed upon including (1) identification of adenomyosis based on MUSA criteria, (2) disease location (anterior, posterior, left lateral, right lateral, fundal), (3) classification of the lesions as focal or diffuse, (4) presence or absence of intralesional cysts, (5) myometrial layer involvement (junctional zone, myometrium, serosal involvement), (6) disease extent (< 25%, 25-50%, > 50% of uterine

2018 Ultrasound in Obstetrics and Gynecology

117. A Multi-omics Study of Adenomyosis

Study Description Go to Brief Summary: This study aims to analyze the multi-omics results between eutopic endometrium, adenomyosis and endometriosis of patients diagnosed of adenomyosis with and without endometriosis. The multi-omics profiles include whole exome sequencing, analysis of transcriptomics and metabolomics. A comprehensive multi-omics will reveal the pathogenesis of adenomyosis. Condition or disease Intervention/treatment Adenomyosis Endometriosis Ectopic Endometrium Eutopic Endometrium (...) provided by the National Library of Medicine related topics: Groups and Cohorts Go to Group/Cohort Intervention/treatment Group of adenomyosis Patients with adenomyosis with or without endometriosis Combination Product: A multi-omics analysis A multi-omics analysis including whole exome sequencing, transcriptomics and metabolomics for eutopic and ectopic endometrium Group of endometriosis Patients with endometriosis without adenomyosis Combination Product: A multi-omics analysis A multi-omics analysis

2018 Clinical Trials

118. Risk of preterm birth, low birthweight, and small-for-gestational-age infants in pregnancies with adenomyosis: a cohort study of the Japan Environment and Children's Study. (Abstract)

with adenomyosis using self-reported questionnaires. Multiple logistic regression analyses were conducted to examine whether adenomyosis was associated with adverse pregnancy outcome. Maternal age, smoking status, method of conception, history of parity, fibroids, endometriosis and body mass index before pregnancy were analyzed as confounding factors.Multiple logistic regression analysis showed that pregnancy with adenomyosis was a risk factor for preterm birth at less than 37 weeks (adjusted odds ratio [aOR (...) Risk of preterm birth, low birthweight, and small-for-gestational-age infants in pregnancies with adenomyosis: a cohort study of the Japan Environment and Children's Study. This study evaluated the risk of preterm birth, low birthweight and small-for-gestational-age neonates born to mothers with adenomyosis during pregnancy.We used the results of a Japanese nationwide prospective birth cohort study, identifying 93 668 singleton deliveries from 2011 to 2014. We identified 314 pregnancies

2018 Acta Obstetricia et Gynecologica Scandinavica

119. A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. Full Text available with Trip Pro

for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility.Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity (...) A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis.Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience.University hospital.Seventy consecutive women who underwent transvaginal ultrasound

2018 Fertility and Sterility

120. Development of a clinical prediction model for diagnosing adenomyosis. Full Text available with Trip Pro

Development of a clinical prediction model for diagnosing adenomyosis. To develop a multivariate prediction model for diagnosing adenomyosis using predictors available through transvaginal ultrasonography and clinical examinations.Prospective observational single-center study.Teaching university hospital.One hundred consecutively enrolled premenopausal women aged 30-50 years, undergoing hysterectomy due to a benign condition and not using hormonal treatment.Preoperative 2-D and 3-D transvaginal (...) ultrasonography investigations were performed, and the results were documented in a standardized form. Clinical information was collected using a questionnaire. Histopathology confirmed the outcome.Diagnostic performance (sensitivity, specificity, area under the curve (AUC)) of a multivariate prediction model for adenomyosis. Independent diagnostic performance of single predictors and their quantitative effect (β) in the final model.The final model showed a good test quality (area under the curve [AUC] = 0.86

2018 Fertility and Sterility

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