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1.
Medicine (Baltimore) ; 99(15): e19712, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282727

RESUMO

Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance.This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis.This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital.A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis.The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.


Assuntos
Adenomiose/cirurgia , Endometriose/cirurgia , Hormônio Liberador de Gonadotropina/agonistas , Histerectomia/efeitos adversos , Neoplasias Pélvicas/cirurgia , Adenomiose/patologia , Adulto , Idoso , Quimioterapia Adjuvante/métodos , Endometriose/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/prevenção & controle , Neoplasias Ovarianas/cirurgia , Neoplasias Pélvicas/epidemiologia , Neoplasias Pélvicas/patologia , Cuidados Pós-Operatórios/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco
2.
Eur J Obstet Gynecol Reprod Biol ; 240: 347-350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31386999

RESUMO

OBJECTIVE: To investigate the correlation between the hysterectomy's surgical approach and post hysterectomy adnexal torsion. STUDY DESIGN: Retrospective cohort study of patients with diagnosed adnexal torsion after hysterectomy (abdominal, vaginal and laparoscopic approaches) in a tertiary care medical center from 2007 through 2017 was done. Demographic data, clinical symptoms, type of previous hysterectomy, surgical findings and treatment were retrospectively reviewed from patient records. To calculate the risk of post-hysterectomy adnexal torsion (PHAH) and evaluate its association with type of hysterectomy, we used a national hysterectomy registry that included all hysterectomy done in region of our medical centre. RESULTS: Eight cases of AT after hysterectomy were operated during the study period, seven after laparoscopic and one after vaginal hysterectomy. Torsion occurred a mean of 27.25 ±â€¯16.65 months (range 3-60 months) after surgery. Mean patient age at AT was 45 ±â€¯4.6 years. All patients presented with abdominal pain, five (62.5%) had nausea and vomiting and one had diarrhoea. Laparoscopic findings revealed ovarian torsion in 5 cases, fallopian tube torsion in one and torsion of the adnexa in two cases. The national hysterectomy registry in the geographic region of our hospital summarized 705 patients with laparoscopic hysterectomy with adnexal preservation. The prevalence of post-laparoscopic hysterectomy adnexal torsion was significant high than after other types of hysterectomy (P < 0.05). CONCLUSION: PHAT occurs more frequently after laparoscopic hysterectomy then after other approaches. Measures for prevention of adnexal torsion should be considered during the primary surgery.


Assuntos
Doenças dos Anexos/etiologia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Anormalidade Torcional/etiologia , Neoplasias Uterinas/cirurgia , Adenomiose/cirurgia , Adulto , Feminino , Humanos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Prolapso Uterino/cirurgia
3.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31341378

RESUMO

Background and Objectives: Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa). Methods: We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects. Results: Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence. Conclusions: GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious.


Assuntos
Adenomiose/cirurgia , Histerectomia/métodos , Laparoscopia/métodos , Leuprolida/administração & dosagem , Pré-Medicação , Adulto , Feminino , Hemoglobinometria , Humanos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Leuprolida/efeitos adversos , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão/efeitos dos fármacos , Estudos Retrospectivos , Fatores de Risco , Ureter/lesões , Bexiga Urinária/lesões , Útero/efeitos dos fármacos
4.
Eur Radiol ; 29(12): 6971-6981, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31264010

RESUMO

OBJECTIVES: To assess the diagnostic accuracy of a junctional zone (JZ) thickness of ≥ 12 mm and morphological features of the JZ in MRI in diagnosing adenomyosis in a premenopausal study population. METHODS: This single-center, prospective observational study consecutively enrolled 93 premenopausal women suffering from a benign gynecological condition, from September 2014 to August 2016. Institutional review board approval and written consent were obtained. All participants underwent MRI and hysterectomy with a histopathological examination. MR images were evaluated in a blinded fashion by two independent readers. The maximum junctional zone thickness (JZmax), presence of JZmax ≥ 12 mm, and any irregular appearance of the JZ (defined as irregular outer or inner borders, focal thickening, presence of high-intensity signal foci, or fingerlike indentations at the inner border) were documented, and the diagnostic performance was evaluated with the AUC, chi-square test, and multiple regression. RESULTS: Adenomyosis was histopathologically confirmed in 57 (61%) of the women. JZmax was not positively correlated with adenomyosis diagnosis (AUC = 0.57, p = 0.26) and did not differ significantly between those with and without adenomyosis (10.3 vs 10.1 mm, p = 0.88), nor was a cutoff of JZmax ≥ 12 mm (n = 30/57 (53%) vs n = 16/36 (44%), p = 0.29). The presence of an irregular JZ showed the best association with adenomyosis among the evaluated signs (sensitivity 74% (95% CI, 60, 85); specificity 83% (95% CI, 67, 94) (p < 0.001)). CONCLUSIONS: JZmax was not correlated with adenomyosis in the present premenopausal study population, but direct signs of adenomyosis such as irregularities of the JZ provided a good diagnostic accuracy. KEY POINTS: • Measuring the junctional zone thickness is of limited value for diagnosing adenomyosis with MRI and should not be used for diagnosing adenomyosis in premenopausal women with moderate disease severity. • An irregular appearance of the junctional zone, the presence of myometrial cysts, and adenomyoma appear to provide the highest specificity for diagnosing adenomyosis. • A consensus for the definition and reading of the junctional zone is needed.


Assuntos
Adenomiose/diagnóstico , Adenomioma/diagnóstico , Adenomioma/cirurgia , Adenomiose/cirurgia , Adulto , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Histerectomia/métodos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Miométrio/patologia , Pré-Menopausa , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
5.
Medicine (Baltimore) ; 98(18): e15466, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045825

RESUMO

We aimed to investigate the feasibility of robotic adenomyomectomy and compared surgical outcomes between laparoscopic and robotic approaches for adenomyomectomy.We retrospectively reviewed the data of women who were diagnosed with adenomyosis and underwent adenomyomectomy through a minimally invasive approach between January 2014 and March 2018 at the CHA Gangnam Medical Center, Seoul, Republic of Korea. Patient demographics and operation-related outcomes were compared between the robotic and laparoscopic surgery groups.We evaluated 43 women who underwent adenomyomectomy through a minimally invasive approach (21 underwent a laparoscopic and 22 underwent a robotic adenomyomectomy). All 22 women who had originally been scheduled to undergo robotic adenomyomectomy could successfully undergo the robotic surgery without requiring conversion to laparotomy and/or serious complications. No statistically significant differences in patient demographics were observed between the robotic and the laparoscopic surgery groups. No significant intergroup difference was observed in the operative time, estimated blood loss, weight of the resected nodule, and length of hospitalization (160.0 vs 212.5 min, P = .106; 500.0 vs 300.0 mL, P = .309; 60.0 vs 70.0 g, P = .932; and 5.0 vs 6.0 days, P = .277). No serious perioperative complications were observed in either group.Robotic adenomyomectomy is feasible for women with adenomyosis. Surgical outcomes of robotic adenomyomectomy were comparable to those of a laparoscopic approach. There was, however, no superiority of robotic adenomyomectomy in terms of surgical outcomes. Further multicenter prospective studies using standardized surgical procedures are needed to confirm the conclusion of this study.


Assuntos
Adenomiose/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Miomectomia Uterina/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Zhonghua Yi Xue Za Zhi ; 99(15): 1152-1155, 2019 Apr 16.
Artigo em Chinês | MEDLINE | ID: mdl-31006218

RESUMO

Objective: To investigate the feasibility and safety of magnetic resonance guided focused ultrasound surgery (MRgFUS) ablation treatment for uterine fibroids and adenomyosis. Methods: From February 2017 to July 2018, a total of 61 women in Foshan Hospital of Traditional Chinese Medicine with uterine fibroids or adenomyosis (36 cases of fibroids and 25 cases of adenomyosis) were included for treatment of MRgFUS, mean age was 27-48 (39±5) years. The treatment status, treatment effect and complications were recorded, and the differences between myoma and adenomyosis were compared. Results: Thirty-two (88.9%) patients of fibroid group and twenty-one (84.0%) patients of adenomyosis group were completed MRgFUS treatment respectively (P>0.05). The spot energy of adenomyosis group was 1 039-5 698(2 852±991) J, which was higher than 600-6 466(2 485±1 137) J of fibroid group (P<0.01). There was no significant statistical difference in mean temperature of spot and ablation time between the two groups (P>0.05).The non-perfusion volume ratio (NPVR) of the fibroid and adenomyosis group was 54%-99%(84%±15%) and 60%-98%(82%±12%) and there was no significant statistical difference (P>0.05), but the ablation efficiencies of adenomyosis group was less than fibroid group (0.8-4.3(2.1±0.9) cm(3)/min vs 1.3-7.8(3.6±1.5)cm(3)/min, P<0.01).The incidence of complications of adenomyosis group was 47.6%(10/21), it was higher than fibroid group 18.8%(6/32) (P<0.05). Conclusions: MRgFUS is a non-invasive, safe and effective treatment for both uterine fibroids and adenomyosis. Compared with uterine fibroids, MRgFUS treatment of adenomyosis has some disadvantages such as higher energy, lower ablation efficiency and more adverse reactions, and further optimization is needed.


Assuntos
Adenomiose , Ablação por Ultrassom Focalizado de Alta Intensidade , Neoplasias Uterinas , Adenomiose/cirurgia , Adulto , Feminino , Humanos , Leiomioma , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Uterinas/cirurgia
7.
West Afr J Med ; 36(1): 88-92, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30924123

RESUMO

BACKGROUND: Adenomyosis is defined by the presence within the myometrium of benign endometrial glands and stroma. Several theories have evolved to explain the pathogenesis of adenomyosis. A third of adenomyosis cases are asymptomatic. Symptoms are however non-specific and are generally related to abnormal vaginal bleeding, pain, infertility, and feeling of pelvic mass. Adenomyosis do coexist with other pathological entities. Diagnosis is achieved through imaging and histology. Treatment could be medical, surgical or a combination of both. The objective of this study was to analyze diagnosed st stcases of adenomyosis, between 1 January 2007, and 31 December 2013 at the Jos University Teaching Hospital in relation to patient's age, common symptoms, and coexisting utero-cervical pathologies. METHODOLOGY: The data from the Medical Records department, Radiology department, and Histopathology department at the Jos University Teaching Hospital, Jos, were mobilized. The information retrieved for each case included: age, symptoms, and coexisting utero-cervical lesions. Archival slides were reviewed to histologically confirm the diagnosis of adenomyosis. In cases with missing slides, archival tissue blocks were retrieved, sectioned into 5µm slides, stained with haematoxylin and eosin, and reviewed microscopically to confirm the diagnosis of adenomyosis. RESULTS: One hundred and fifty seven (157) cases of adenomyosis were diagnosed at the Jos University Teaching Hospital. All cases were histologically diagnosed retrospectively after hysterectomy. The cases were divided into two broad groups: 107(68.2%) cases with adenomyosis only (A), and 50(31.8%) with coexistence of adenomyosis and leiomyoma (AL). The mean age for the general study population was 43.57+8.56, while those for A and AL groups were 44.37+9.12, and 41.86+6.99 respectively. The age group 41-50 years had the highest number of cases in both the A and AL groups: 53(49.5%) and 21(42.0%) cases respectively. The most frequent symptom was menorrhagia, occurring in 87(81.3%), 43(86.0%), and 130(82.8%) cases in the A, AL, and general population respectively. CONCLUSION: Adenomyosis is commoner in the fourth decade of life. It commonly coexists with leiomyoma with menorrhagia being the most frequent symptom. Retrospective histology after a hysterectomy is the diagnostic tool for the disease in our center.


Assuntos
Adenomiose/patologia , Histerectomia/métodos , Leiomioma/patologia , Menorragia/etiologia , Adenomiose/cirurgia , Adulto , Feminino , Humanos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos
8.
Minerva Ginecol ; 71(3): 177-181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30486633

RESUMO

BACKGROUND: The objective of this study is to evaluate the prevalence of adenomyosis, leiomyomas and of their concomitance in women who underwent hysterectomy. METHODS: An observational study carried out on a cohort of 347 women who underwent hysterectomy from a sample of 2383 patients who had gynecological surgery for benign disease in a single University Hospital between 2013 and 2016. A histological evaluation of all surgical specimens was carried out for the presence of adenomyosis and leiomyomas. Prevalence of adenomyosis alone, of leiomyomas alone or of their concomitance was evaluated. RESULTS: In 140 women, indication to hysterectomy was an abnormal uterine bleeding, or pelvic pain (symptomatic), while in the remaining 207 hysterectomy was performed in postmenopausal women for uterine descent or concomitantly to ovariectomy. Mean age of women in the two groups at hysterectomy was 47.7±5.3 years and 68.9±7.9 years, respectively. Prevalence of adenomyosis (40% vs. 27%; P<0.0001) and of leiomyomas (70.7% vs. 50.7%; P<0.0001) was more frequent in symptomatic than post-menopausal women. Concomitant presence of adenomyosis and leiomyomas was also more prevalent in symptomatic than post-menopausal women (30% vs. 14%; P<0.0001). About 75% of the uteri of symptomatic women with adenomyosis had also leiomyomas and 42.4% of those with leiomyomas has also adenomyosis. CONCLUSIONS: In symptomatic women, adenomyosis and leiomyomas are frequent and coexist in 30% of cases. Coexistence of the two pathologies should be considered in women suffering of heavy menstrual bleeding and menstrual pain.


Assuntos
Adenomiose/epidemiologia , Adenomiose/patologia , Leiomioma/epidemiologia , Leiomioma/patologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Adenomiose/cirurgia , Adulto , Idoso , Feminino , Humanos , Histerectomia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Prevalência , Neoplasias Uterinas/cirurgia
9.
J Minim Invasive Gynecol ; 26(5): 941-948, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30273686

RESUMO

STUDY OBJECTIVE: To examine the presence of sonographic evidence of adenomyosis (SEOA) in patients undergoing laparoscopic surgery for the investigation of endometriosis and to assess if there is an association between SEOA and endometriosis severity. Using gene expression analysis, we also aimed to determine if gene expression in eutopic endometria differed in patients with and without adenomyosis. DESIGN: A prospective study (Canadian Task Force classification II-2). SETTING: A tertiary medical center. PATIENTS: Reproductive-age women who underwent laparoscopic surgery after presenting to a pelvic pain-focused gynecology clinic. INTERVENTIONS: Endometrial tissue, detailed patient questionnaires, pathology, and surgical notes were collected. Sonographic data from tertiary ultrasounds performed up to 12 months before surgery were retrospectively added (n = 234, researchers blinded to surgical and pathological findings). Gene array data from endometrial biopsies (n = 41) were used to analyze differential gene expression; patients were divided into 2 groups according to the presence or absence of SEOA. MEASUREMENTS AND MAIN RESULTS: Of the 588 patients recruited, 234 (40%) had an available pelvic scan and were included in this study. The average age of the included women was 30.6 years, with 35% having SEOA. Patients with SEOA were 5.4 years older (p = .02). There was no significant difference in the rates of endometriosis between groups; however, patients with SEOA were more likely to have stage IV endometriosis (41% vs 9.8%, p <.001). Patients with SEOA were also more likely to have other markers of severe endometriosis such as endometriomas and deep infiltrating endometriosis (p <.001). No significant difference was observed in endometrial gene expression between adenomyosis cases and controls after adjusting for menstrual c`ycle phases and the presence/absence of endometriosis. CONCLUSION: Sonographic features of adenomyosis may be included as a component of the clinical assessment when attempting to predict the presence of severe endometriosis. No differences in gene expression were observed. Further research is needed to characterize uterine adenomyosis and to explore molecular pathways involved in its pathogenesis.


Assuntos
Adenomiose , Endometriose , Endométrio/metabolismo , Doenças Peritoneais , Adenomiose/complicações , Adenomiose/diagnóstico , Adenomiose/genética , Adenomiose/cirurgia , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/genética , Endometriose/cirurgia , Endométrio/patologia , Feminino , Expressão Gênica , Perfilação da Expressão Gênica , Humanos , Laparoscopia , Análise em Microsséries , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/genética , Dor Pélvica/cirurgia , Doenças Peritoneais/complicações , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/genética , Doenças Peritoneais/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia , Adulto Jovem
10.
J Minim Invasive Gynecol ; 26(5): 891-896, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30205164

RESUMO

STUDY OBJECTIVE: To compare symptom persistence in women with adenomyosis based on retention or removal of the cervix at the time of hysterectomy. DESIGN: Retrospective cohort study and follow-up survey (Canadian Task Force classification xx). SETTING: Tertiary care academic hospital in Boston, Massachusetts. PATIENTS: Women (n = 1580) who underwent laparoscopic hysterectomy for benign indications between 2008 and 2012 at Brigham and Women's Faulkner Hospital and Brigham and Women's Hospital. INTERVENTION: Retrospective chart review and follow-up survey. MEASUREMENTS AND MAIN RESULTS: Among the 1580 women contacted, 762 (48%) responded to the postoperative symptom resolution survey. Of these 762 women, 623 agreed to participate in the study. Menopausal women or those who had undergone bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 women (39%). Compared with women without adenomyosis, those with adenomyosis were older on average (mean age, 46.6 ± 6.8 years vs 45.0 ± 5.5 years; p = .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%; p = .03 and 64.9% vs 51.4%; p = .009, respectively). The rates of total and supracervical hysterectomies were similar in the 2 groups. Following surgery, women with adenomyosis were less likely than those without adenomyosis to report persistent pain (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.20-0.93; p = .03). Persistent bleeding was similar in the 2 groups (aOR, 0.97; 95% CI, 0.49-1.93; p = .94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at the time of hysterectomy. CONCLUSION: Compared with women without adenomyosis, those with histopathologically proven adenomyosis were less likely to report persistent pain following hysterectomy. Retention of the cervix does not appear to increase the risk of symptom persistence or postprocedure patient satisfaction.


Assuntos
Adenomiose/cirurgia , Colo do Útero/cirurgia , Histerectomia/efeitos adversos , Histerectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Adulto , Boston , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários , Avaliação de Sintomas , Resultado do Tratamento
11.
Eur Radiol ; 29(3): 1144-1152, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30159623

RESUMO

OBJECTIVES: To describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations. METHODS: Eleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings. RESULTS: All 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17-60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis. CONCLUSIONS: On MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. KEY POINTS: • ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. • Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament. • On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.


Assuntos
Adenomiose/diagnóstico , Endometriose/diagnóstico , Imagem por Ressonância Magnética/métodos , Útero/patologia , Adenomiose/cirurgia , Adolescente , Adulto , Diagnóstico Diferencial , Endometriose/cirurgia , Feminino , Humanos , Histerectomia , Laparoscopia , Estudos Retrospectivos , Útero/cirurgia , Adulto Jovem
12.
Acta Obstet Gynecol Scand ; 98(2): 205-214, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30317553

RESUMO

INTRODUCTION: Our aim was to correlate junctional zone thickening and irregularity (junctional zone disease) and other ultrasonographic features of adenomyosis with the histopathology of the endometrial-myometrial junctional zone. MATERIAL AND METHODS: Consecutively enrolled premenopausal women (n = 110) scheduled for hysterectomy or transcervical endometrial resection due to abnormal uterine bleeding and/or menstrual pain, underwent two- and three-dimensional transvaginal ultrasonography on the day of surgery with the observer blinded to previous diagnosis. Junctional zone maximum thickness (JZmax ), junctional zone maximum irregularity (JZdif ) and ultrasonographic characteristics of adenomyosis were compared with histopathology of the junctional zone defined as (1) adenomyosis of the inner myometrium, ≥2 mm myometrial invasion without contact to the basal endometrium, (2) serrated junctional zone, >3 mm myometrial invasion with contact to the basal endometrium or (3) linear junctional zone, no or marginal myometrial invasion ≤3 mm with contact to the basal endometrium. RESULTS: Adenomyosis of the inner myometrium, serrated junctional zone and linear junctional zone was present in 29%, 35% and 35% of the women, respectively. Median JZmax and median JZdif expanded from linear junctional zone (8.5 and 3.3 mm) to serrated junctional zone (10.1 and 4.1 mm) to adenomyosis of the inner myometrium (14.6 and 9.2 mm) (P < 0.05). In addition, the median number of characteristic adenomyosis-like ultrasonographic features increased from the linear junctional zone to the serrated junctional zone to adenomyosis of the inner myometrium (P < 0.05). CONCLUSIONS: A slightly thickened and/or irregular junctional zone corresponds to a histopathologically defined serrated junctional zone. This study emphasizes three distinct appearances of the junctional zone: adenomyosis of the inner myometrium, junctional zone disease (serrated junctional zone) and linear junctional zone. This classification may be useful in future clinical studies.


Assuntos
Adenomiose , Endométrio , Miométrio , Ultrassonografia/métodos , Doenças Uterinas , Hemorragia Uterina , Adenomiose/diagnóstico , Adenomiose/patologia , Adenomiose/cirurgia , Adulto , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histerectomia Vaginal/métodos , Miométrio/diagnóstico por imagem , Miométrio/patologia , Tamanho do Órgão , Pré-Menopausa , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes , Doenças Uterinas/diagnóstico , Doenças Uterinas/patologia , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/patologia , Hemorragia Uterina/cirurgia
13.
Diagn Interv Radiol ; 24(6): 364-371, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30373724

RESUMO

PURPOSE: We aimed to identify predisposing factors that could help predict the therapeutic response of adenomyosis after uterine artery embolization (UAE). METHODS: This was a retrospective, single-center study of patients admitted to the hospital for adenomyosis between 2013 and 2015. Sixty-eight patients with adenomyosis who underwent UAE with tris-acryl gelatin microspheres were divided into two groups based on their therapeutic response (complete or incomplete necrosis of lesions), and pre- and postprocedural pelvic magnetic resonance imaging (MRI) data. Patients were followed up for 12 months after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the symptom relief criteria. Improvement rates in both groups were analyzed and compared. Multivariate logistic regression analysis was used to identify the predisposing factors from retrospectively gathered baseline data that might affect the therapeutic response, including MRI features, clinical symptoms, biochemical index, and accompanying diseases of adenomyosis. Then, a prognostic model was established, and the receiver operating characteristic (ROC) curve of identified factors was drawn to determine their predictive value. RESULTS: Following UAE, 46 patients (67.6%) showed complete necrosis, while 22 patients (32.4%) showed incomplete necrosis. At 12-month follow-up, dysmenorrhea symptom improvement was seen in 94.7% of complete necrosis and 50% of incomplete necrosis group (P < 0.001); menorrhagia symptom improvement was seen in 96.2% of complete necrosis and 57.1% of incomplete necrosis groups (P = 0.004). Multivariate logistic regression analysis determined serum cancer antigen 125 (CA125) levels (odds ratio [OR], 1.006; 95% confidence interval [CI], 1.002-1.010; P = 0.005) and accompanying endometriosis (OR, 6.869; 95% CI, 1.881-25.016; P = 0.004) as predisposing factors. The areas under the ROC curve of CA125, endometriosis, and these two indicators combined were 0.785, 0.708, and 0.845, which corresponded to sensitivities of 95.5%, 66.7%, and 68.2% and specificities of 52.2%, 80.0%, and 87.0% at optimal cutoff values, respectively. CONCLUSION: Symptom relief of dysmenorrhea and menorrhagia for patients with complete necrosis was significantly better than that for patients with incomplete necrosis. Serum CA125 levels and accompanying endometriosis can effectively distinguish complete necrosis from incomplete necrosis.


Assuntos
Adenomiose/sangue , Adenomiose/cirurgia , Antígeno Ca-125/sangue , Endometriose/sangue , Endometriose/complicações , Proteínas de Membrana/sangue , Embolização da Artéria Uterina/métodos , Adenomiose/complicações , Adulto , Endometriose/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Miométrio/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Fertil Steril ; 110(5): 957-964.e3, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30316443

RESUMO

OBJECTIVE: To develop a multivariate prediction model for diagnosing adenomyosis using predictors available through transvaginal ultrasonography and clinical examinations. DESIGN: Prospective observational single-center study. SETTING: Teaching university hospital. PATIENT(S): One hundred consecutively enrolled premenopausal women aged 30-50 years, undergoing hysterectomy due to a benign condition and not using hormonal treatment. INTERVENTION(S): 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. MAIN OUTCOME MEASURE(S): 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 (ß) in the final model. RESULT(S): The final model showed a good test quality (area under the curve [AUC] = 0.86, [95% confidence interval = 0.79-0.94], optimal cutoff 0.56, sensitivity of 85%, specificity 78%). The following nine predictors were included ([sensitivity, specificity, ß] or [AUC, ß]): presence of myometrial cysts (51%, 86%, ß = 0.86), fan-shaped echo (36%, 92%, ß = 0.54), hyperechoic islets (51%, 78%, ß = 0.62), globular uterus (61%, 83%, ß = 0.2), normal uterine shape (83%, 61%, ß = -0.75), thickest/thinnest ratio for uterine wall (0.61, ß = 0.26), maximum width of the junctional zone in sagittal plane (0.71, ß = 0.1), regular appearance of junctional zone (31%, 92%, ß = -1.0), and grade of dysmenorrhea measured on a verbal numerical rating scale (0.61, ß = 0.08). CONCLUSION(S): We have presented a multivariate model for diagnosing adenomyosis that weights predictors based on their diagnostic significance. The reported findings could aid clinicians who are interpreting the heterogeneous appearance of adenomyosis in ultrasonography. CLINICAL TRIAL REGISTRATION NUMBER: NCT02201719.


Assuntos
Adenomiose/diagnóstico por imagem , Adenomiose/epidemiologia , Modelos Teóricos , Útero/diagnóstico por imagem , Adenomiose/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Útero/cirurgia
15.
Int J Hyperthermia ; 35(1): 626-636, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30307340

RESUMO

OBJECTIVE: This retrospective study aimed (1) to investigate the magnetic resonance imaging (MRI) features influencing a nonperfused volume ratio (NPVr) ≥ 90% after high-intensity focussed ultrasound (HIFU) ablation of adenomyosis, and (2) to assess the safety, which was defined in terms of adverse events (AEs) and changes in anti-Mullerian hormone (AMH) concentrations, and clinical efficacy, which was defined in terms of adenomyosis volume reduction and symptom improvement at 6 months' follow-up. METHODS: Sixty-six women who underwent HIFU treatment were divided into groups A (NPVr ≥90%; n = 26) and B (NPVr <90%, n = 40). Multivariate logistic regression analyses of MRI features were conducted to identify the potential predictors of an NPVr ≥90%. RESULTS: Generalized estimating equation (GEE) analysis was used to model the prediction of an NPVr ≥90% with four significant predictors from multivariate analyses: the thickness of the subcutaneous fat layer, adenomyosis volume, T2 signal intensity (SI) ratio of adenomyosis to myometrium, and the Ktrans ratio of adenomyosis to myometrium. Clinical efficacy was significantly greater in group A than in group B. The findings showed no serious AEs and no significant differences between AMH concentrations before and 6 months after treatment. CONCLUSIONS: The present retrospective study demonstrated that achievement of NPVr ≥90% as a measure of clinical treatment success in MRI-guided HIFU treatment of adenomyosis using multivariate analyses and a prediction model is clinically possible without compromising the safety of patients.


Assuntos
Adenomiose/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
16.
Taiwan J Obstet Gynecol ; 57(5): 753-754, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30342666

RESUMO

OBJECTIVE: Residual ovarian syndrome (ROS) occurs after a hysterectomy in which one or both ovaries have been preserved and cause chronic pelvic pain, an asymptomatic pelvic mass, or dyspareunia. We present a case with classic symptoms and imaging and pathology findings, and review the treatment of residual ovarian syndrome. CASE REPORT: A 35-year-old woman with a diagnosis of ROS. CONCLUSION: Based on previous literature, almost 50% of patients with ROS require surgery for their symptoms. Treatment of ROS with gonadotropin-releasing hormone analogs or high dose progestogens may be helpful. However, there are limited data supporting the efficacy of pharmacologic therapy. Patients receiving pharmacologic therapy should be counseled about the limited data supporting the efficacy of this approach, the lack of a histologic diagnosis, and the risk of ovarian cancer in residual tissue.


Assuntos
Dismenorreia/cirurgia , Histerectomia/efeitos adversos , Menorragia/cirurgia , Cistos Ovarianos/etiologia , Doenças Ovarianas/etiologia , Ovário/patologia , Dor Abdominal , Adenomiose/complicações , Adenomiose/patologia , Adenomiose/cirurgia , Adulto , Dismenorreia/etiologia , Feminino , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Menorragia/etiologia , Cistos Ovarianos/cirurgia , Doenças Ovarianas/patologia , Doenças Ovarianas/terapia , Ovariectomia , Progestinas/uso terapêutico , Salpingectomia , Síndrome
17.
Biomed Res Int ; 2018: 1657237, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30112362

RESUMO

Objective: To evaluate the feasibility, safety, and efficacy of a new surgical method of U-shaped myometrial excavation and modified suture approach with uterus preservation for diffuse adenomyosis. Methods: From January 2012 to December 2014, 198 patients with diffuse adenomyosis were surgically treated using this novel procedure in Zhengzhou Hua-Shan Hospital. Degree of dysmenorrhea, menstrual blood volume, serum CA 125, and uterine size before and at 1 month, 3 months, 6 months, 12 months, and 24 months after surgery were compared. Results: Postoperatively, VAS score of dysmenorrhea, menstrual blood volume, serum CA 125 level, and uterine size significantly decreased at 1 month, 3 months, 6 months, 12 months, and 24 months from presurgical levels (all p < .001), but there were no differences at the follow-up time points. Two patients recurred at 18 months and 23 months after surgery, but both recovered after repeat surgery. Interestingly, 2 other patients recrudesced at 10 months and 12 months after surgery. In addition, only one patient was found to have a postoperative anaemia with fever, conservatively managed without surgery. Conclusion: U-shaped myometrial excavation and modified suture approach with uterus preservation is a safe and feasible surgical approach to treat diffuse adenomyosis, with favourable outcomes.


Assuntos
Adenomiose/cirurgia , Preservação de Órgãos/métodos , Técnicas de Sutura , Dismenorreia , Feminino , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Útero
18.
J Obstet Gynaecol Res ; 44(9): 1787-1792, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29998482

RESUMO

AIM: Menorrhagia and dysmenorrhea are common symptoms. Uterine adenomyosis is one of the causes of menorrhagia and dysmenorrhea. These symptoms often decrease the quality of life in women. Microwave endometrial ablation (MEA) is a recently developed procedure that enables endometrial ablation. Dienogest has long been used to suppress endometrium development and reduce adenomyosis-related dysmenorrhea. However, some cases could be resistant to dienogest. In this study, we evaluated the efficacy of a combination of MEA and postoperative dienogest in reducing adenomyosis-related dysmenorrhea and menorrhagia. METHODS: Ten patients with hormone treatment-resistant symptomatic adenomyosis underwent MEA and were administered oral dienogest after the procedure. The primary endpoints were reduction in pain recurrence and anemia. The secondary endpoint was a change in the adenomyosis lesion and its symptomatic recurrence. RESULTS: Statistically significant improvements were seen in the visual analog scale score and hemoglobin levels in women post-treatment. The difference in myometrial thickness pre- and post-MEA was statistically significant. There were no cases of symptomatic recurrence. CONCLUSION: The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea.


Assuntos
Adenomiose , Dismenorreia , Técnicas de Ablação Endometrial/métodos , Antagonistas de Hormônios/farmacologia , Menorragia , Micro-Ondas/uso terapêutico , Nandrolona/análogos & derivados , Adenomiose/complicações , Adenomiose/tratamento farmacológico , Adenomiose/cirurgia , Adulto , Terapia Combinada , Dismenorreia/tratamento farmacológico , Dismenorreia/etiologia , Dismenorreia/cirurgia , Feminino , Antagonistas de Hormônios/administração & dosagem , Humanos , Menorragia/tratamento farmacológico , Menorragia/etiologia , Menorragia/cirurgia , Pessoa de Meia-Idade , Nandrolona/administração & dosagem , Nandrolona/farmacologia , Estudos Retrospectivos
19.
Eur J Obstet Gynecol Reprod Biol ; 227: 46-51, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29886317

RESUMO

OBJECTIVE: To evaluate the efficacy of NovaSure® radiofrequency global endometrial ablation (GEA) in adenomyosis. STUDY DESIGN: We conducted a monocentric longitudinal cohort study at Croix-Rousse University Hospital (Lyon, France). Inclusion criteria were symptomatic adenomyosis resistant to drug therapy (dysmenorrhea and abnormal uterine bleeding (AUB)), for whom Novasure® GEA was considered. The diagnosis of adenomyosis was based on ultrasound and/or MRI criteria. A questionnaire evaluating the symptoms was proposed to each patient before GEA and postoperatively at 6 months and 3 years. RESULTS: Forty-three patients were included between December 2012 and May 2014, with a median age of 46.7 years. Preoperatively, 43 patients (100%) had AUB and 33 (76.7%) had dysmenorrhea,. Postoperatively, there was a significant reduction in AUB in 40 patients (-93%, 95% CI [85.3, 100], p < .00001) at 6 months, and in 29 patients (-67.4%, 95% CI [53.3, 81.6], p < .00001) at 3 years. Eleven patients (+ 25.5%, 95% CI [10.9, 40.3], p = .0055) experienced significant recurrence of AUB between 6 months and 3 years. Eighteen patients (41.9%, 95% CI [26.9, 56.8], p < .00001) experienced amenorrhea 6 months after the procedure, and 16 patients (37.2%, 95% CI [22.6, 51.8], p < .00001) at 3 years. Similarly, we observed a significant decrease of dysmenorrhea with an improvement in 20 patients (-60.6%, 95% CI [-46.7, -77.5], p = .00002) at 6 months and 17 patients (-51.5%, 95% CI [34.2, 68.8], p = .0001) at 3 years. The recurrence of dysmenorrhea between 6 months and 3 years in 3 patients (+ 9.1%, 95% CI [-8.7, +26.9], p = .44) was not significant. Eight patients (19%) had a hysterectomy during the study. Patients were 92% satisfied with the procedure. No major postoperative complication was reported after using NovaSure®. CONCLUSION: NovaSure® is effective in the treatment of painful and hemorrhagic symptoms associated with adenomyosis in both the short and long term. However, efficacy in controlling bleeding seems to decrease over time. Nevertheless, it appears to be a good alternative to hysterectomy in this indication, especially in patients close to menopause.


Assuntos
Adenomiose/cirurgia , Dismenorreia/cirurgia , Técnicas de Ablação Endometrial/métodos , Adulto , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Biomed Res Int ; 2018: 6832685, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29736395

RESUMO

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.


Assuntos
Adenomiose/cirurgia , Histerectomia/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Adenomiose/fisiopatologia , Feminino , Fertilidade/fisiologia , Preservação da Fertilidade/métodos , Humanos
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