adenomyoma

Adenomyoma Description

An adenomyoma is a type of non-cancerous tumor that consists of endometrial gland tissue and smooth muscle in the myometrium, which is the muscular layer of the uterus. It is a localized form of uterine adenomyosis, characterized by a focus of endometrial glands and stroma within the myometrium.

Key Features

• Composed of endometrial gland tissue and smooth muscle
• Localized to the myometrium, with a well-circumscribed border
• Can be confused with leiomyomas on imaging and pathological examination
• Typically exhibits low signal intensity on T2-weighted images

Comparison to Adenomyosis

While adenomyosis is characterized by diffuse growth of endometrial tissue into the myometrium, an adenomyoma is a more localized and well-circumscribed form of this condition. The gland-to-stroma ratio in adenomyomas can vary widely, and some may have attenuated or undetectable stromal components.

References

• [8] Adenomyoma is a tumor (-oma) including components derived from glands (adeno-) and muscle (-my-).
• [11] Adenomyoma is a localized and well-circumscribed form of adenomyosis.
• [15] Uterine adenomyoma, the localized form of uterine adenomyosis, is a tumor composed of endometrial gland tissue and smooth muscle in the myometrium.

Symptoms of Adenomyosis

Adenomyosis, also known as focal adenomyosis or adenomyoma, can cause a range of symptoms that vary in severity from woman to woman. Some common signs and symptoms include:

• Painful periods: Cramping and pain during menstruation are common complaints among women with adenomyosis.
• Heavy bleeding: Menstrual flow may be heavier than usual, leading to discomfort and potential complications.
• Pelvic pain: Pain in the lower part of the tummy (abdomen) can occur at any time during the menstrual cycle, not just during periods.
• Bloating, heaviness or fullness: Women with adenomyosis may experience bloating, a feeling of fullness or heaviness in the abdomen, which can be uncomfortable and affect daily activities.
• Pain during sex: Some women may experience pain or discomfort during intercourse due to the condition.

Other symptoms

In some cases, adenomyosis can cause additional symptoms, such as:

• Increased uterine size: The uterus may appear larger than usual, similar to how it increases in early pregnancy.
• Globular appearance: The uterus may take on a rounded or globular shape due to the growth of adenomyotic tissue.

Severity and impact

Symptoms of adenomyosis can range from mild to severe, affecting daily life and overall well-being. In some cases, symptoms may be minimal, while in others, they can be debilitating and interfere with normal activities.

References:

• [11] Focal adenomyosis is also called an adenomyoma.
• [13] Symptoms of adenomyosis. Some symptoms of adenomyosis affect your periods, such as: painful periods; heavy bleeding during your period; Other symptoms can happen any time in your menstrual cycle, such as: pelvic pain (pain in the lower part of your tummy) bloating, heaviness or fullness in your tummy (abdomen) pain during sex

Diagnosing adenomyosis, including adenomyoma, can be challenging due to its similarity in symptoms and appearance to other uterine conditions. However, several diagnostic tests can help confirm the presence of adenomyosis.

• Ultrasound: A transvaginal ultrasound is a common first-line test for diagnosing adenomyosis. It uses sound waves to produce images of the pelvic organs, which can show signs of adenomyosis such as a spongy or globular uterus [3]. However, ultrasound cannot definitively diagnose adenomyosis and may be confused with other conditions like fibroids.
• MRI: Magnetic Resonance Imaging (MRI) has been shown to be highly accurate in making the diagnosis of adenomyosis. The most important MRI finding for diagnosing adenomyosis is the presence of JZ thickening >12 mm [6]. Another significant finding is the presence of hypervascularization or submucosal hemorrhagic cysts.
• Transvaginal Sonography (TVS): TVS has been reported to be a useful and dependable diagnostic tool in diagnosing adenomyosis, with high accuracy rates [8].
• Histological examination: The gold standard for diagnosing adenomyosis is histological examination of hysterectomy specimens. However, this is typically only done after other diagnostic tests have confirmed the presence of adenomyosis.

It's worth noting that uniform diagnostic criteria are needed to standardize the diagnosis and provide reliable updated figures [12].

Treatment Options for Adenomyosis

Adenomyosis, a condition characterized by the growth of endometrial tissue within the uterine wall, can be managed with various treatment options. While there is no cure for adenomyosis, drug treatments can help alleviate symptoms and improve quality of life.

• Hormonal Contraceptives: Hormonal contraceptives are often the first-line treatment for adenomyosis symptoms. These include birth control tablets and progesterone-releasing intrauterine devices (IUDs) [15]. Studies have shown that hormonal contraceptives can effectively reduce excessive bleeding and period cramps in women with adenomyosis [3].
• Progestins: Progestins, such as LNG-IUS (levonorgestrel-releasing intrauterine system) and oral dienogest, are commonly used in adenomyosis management [3]. These medications can help reduce menstrual bleeding and alleviate symptoms.
• Anti-inflammatory Drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), can be prescribed to control pain and inflammation associated with adenomyosis [1].
• Mifepristone: Mifepristone, a medication used for medical abortion, has been studied as a potential treatment for adenomyosis. A randomized clinical trial found that mifepristone was effective and safe for the treatment of adenomyosis [9].

Limitations and Future Directions

While drug treatments can provide relief from symptoms, they may not be effective for all women with adenomyosis. The majority of currently used drugs are off-label, and there is a need for better long-term treatment options [14]. Newer medications, such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelet therapy, are under development for the treatment of adenomyosis [11].

References

[1] Search result 8 [3] Search result 3 [9] Search result 9 [11] Search result 11 [14] Search result 14 [15] Search result 15