Hysteroscopic management of submucous cystic adenomyosis
Tuesday - January 3, 2017 4:27 am
Adenomyosis is a benign condition of uterus characterized by the presence of endometrial glands and stroma invading the myometrium with the presence of hyperplasia and hypertrophy of the smooth muscle fibers. It occurs mostly in women between the fourth and fifth decade of life. Adenomyosis is often associated risk factors like multiparity, previous uterine surgery and presence of endometriosis; and like the latter, it is also oestrogen sensitive.
While some women diagnosed with adenomyosis have no symptoms, the disease can cause:
1. Heavy, prolonged menstrual bleeding
2. Severe menstrual cramps
3. Abdominal pressure and bloating
Adenomyosis is of two forms of presentation which are described focal and diffuse. Focal adenomyosis may occur as a well circumscribed nodular lesion (adenomyoma), similar to an intramural fibroid or restricted to one uterine wall structure in the form of localized adenomyosis. By contrast, the diffuse form is one in which can affect the entire uterus without demarcated boundaries between invaded tissue and surrounding healthy myometrium.
Until recently, the only definitive way to diagnose adenomyosis was to perform a hysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.
With the use of modern improved imaging techniques, it is possible that a growing number of cases in adolescents and young adult women with dysmenorrhea, emerging a new type of adenomyosis called "cystic". At present, the diagnosis is mainly based on MRI, presenting as a cystic structure with an internal diameter ≥10 mm and hemorrhagic content surrounded by myometrial tissue. In a review of cystic adenomyosis, Brosens et al (2015) described three types (A, B, and C) with their respective subtypes, according to the location of the cyst and the complexity of the lesion.
If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms.