Research
General gynecology
Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification

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Objective

The aim of the present study was to differentiate and specify the subtypes of adenomyosis.

Study Design

Surgically treated adenomyosis (n = 152) was subcategorized retrospectively into 4 subtypes on the basis of magnetic resonance imaging geography. Subtype I (n = 59) consisted of adenomyosis that occurs in the uterine inner layer without affecting the outer structures. Subtype II (n = 51) consisted of adenomyosis that occurs in the uterine outer layer without affecting the inner structures. Subtype III (n = 22) consisted of adenomyosis that occurs solitarily without relationship to structural components. Adenomyosis that did not satisfy these criteria composed subtype IV (n = 20). Stepwise logistic regression analysis was used for specification of the subtypes.

Results

Subtypes I-III were suggested as a product of direct endometrial invasion, endometriotic invasion from the outside, and de novo metaplasia, respectively. Subtype IV was a heterogeneous mixture of far advanced disease.

Conclusion

Adenomyosis appears to consist of 3 distinct subtypes of different causes and an additional subtype of indeterminate cause.

Section snippets

Materials and Methods

We investigated 163 patients with adenomyosis who were treated surgically in the Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan, during the period from April 2007 through to August 2011. The surgery consisted of hysterectomy (n = 40) and adenomyomectomy (n = 123) that were performed laparoscopically in most cases (n = 155; 95.1%). In 11 of the 163 patients, MRI films were not available because they were taken at different institutions and were returned to the

Results

The patients' background aspects, symptoms, MRI findings, surgical findings, and histologic findings are summarized according to the subtypes (Table 1). There were no between-subtype differences in the symptoms; quite a number of other variables show statistical significance.

To find the variables that were responsible for discrimination and specification of the subtypes, stepwise logistic regression analyses were performed. Table 2 depicts the results of the analysis for subtype I as the

Comments

Adenomyosis is defined as a pathologic condition in which endometrial or endometrium-like structures are present and function in the myometrium. It has been accepted for a long period of time that adenomyosis develops as a result of direct invasion of the endometrium into the myometrium. This causes thickening and aberrancy of the junctional zone, which has been the diagnostic criteria of adenomyosis.3 Of course, there are patients who satisfy this criteria (Figure 1, A). However, this is not

Acknowledgment

We thank Dr G. Honjo, Department of Pathology, Tennri Hospital, Tennri, Nara, Japan, for the production of histologic pictures.

References (8)

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The authors report no conflict of interest.

Cite this article as: Kishi Y, Suginami H, Kuramori R, et al. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 2012;207:114.e1-7.

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