Distinct types of uterine adenomyosis based on laparoscopic and histopathologic criteria.
OBJECTIVE
To analyze laparoscopically treated cases of adenomyosis based on intraoperative and histopathology findings and to correlate different types with patients' presenting symptoms and characteristics, as well as with the surgical approach.


METHODS
Sixty-eight women who underwent laparoscopic treatment of adenomyosis at a referral center for gynecological laparoscopy.


RESULTS
Four distinct types of adenomyosis could be identified: diffuse, sclerotic, nodular, and cystic (54.5%, 13%, 28%, and 4.5% of cases, respectively). Menorrhagia as the main presenting symptom was significantly more frequent in patients with the diffuse type (84%) compared to those with sclerotic (44%) and nodular (37%) types (p = 0.025 andp = 0.001, respectively). All cases of cystic and nodular adenomyosis were treated by laparoscopic excision of the lesion. Eighty-nine percent of patients with sclerotic adenomyosis were treated with wide laparoscopic excision of the abnormal tissue. Eighty-one percent of patients with diffuse adenomyosis were treated with laparoscopic hysterectomy.


CONCLUSIONS
Adenomyosis can be classified in four distinct types with differences in the presenting symptoms, as well as in the ideal surgical approach.
G
G
Pistofidis
E
E
Makrakis
O
O
Koukoura
N
N
Bardis
P
P
Balinakos
V
V
Anaf
D062788:Adenomyosis / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D004412:Dysmenorrhea / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007889:Leiomyoma / Q000150:complications / Q000601:surgery; D008595:Menorrhagia / Q000209:etiology; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology