title: Preoperative and Postoperative Clinical and Transvaginal Ultrasound Findings of Adenomyosis in Patients With Deep Infiltrating Endometriosis.
abstract: OBJECTIVE
  Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre- and postoperative symptoms.
  
  
  METHODS
  A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by 2-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3-6 months after surgery) was done.
  
  
  RESULTS
  A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (P = .0019), dyspareunia (P = .0004), and abnormal uterine bleeding (P < .001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (P < .001) in the group with adenomyosis.
  
  
  CONCLUSIONS
  Deep infiltrating endometriosis is frequently associated with adenomyosis, significantly affecting pre- and postoperative symptoms and thus influencing the follow-up management.
authors: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy lucia.lazzeri@unisi.it lucialazzeri@email.it.
authors: Lucia
authors: L
authors: Lazzeri
authors: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
authors: Alessandra
authors: A
authors: Di Giovanni
authors: Department of Obstetrics and Gynecology, University of Rome "Tor Vergata", Roma, Italy.
authors: Caterina
authors: C
authors: Exacoustos
authors: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors: Claudia
authors: C
authors: Tosti
authors: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors: Serena
authors: S
authors: Pinzauti
authors: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
authors: Mario
authors: M
authors: Malzoni
authors: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors: Felice
authors: F
authors: Petraglia
authors: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors: Errico
authors: E
authors: Zupi
keywords: adenomyosis; deep infiltrating endometriosis; dysmenorrhea; heavy menstrual bleeding; transvaginal ultrasound