Pathogenesis of adenomyosis

In: Journal of obstetrics and women's diseases · 2020 · vol. 69(4) , pp. 73–82 · doi:10.17816/jowd69473-82 · W3091025622
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This review examines the etiology, pathogenesis, and diagnosis of adenomyosis, an independent disease involving molecular, genomic, and immune changes, with a focus on the junctional zone and its impact on fertility.

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This review paper examines the etiology, pathogenesis, and diagnosis of adenomyosis, focusing on women of reproductive age and synthesizing evidence from studies on molecular/genomic/immune mechanisms and imaging approaches. It highlights that a key initial morphological and functional feature is altered structure of the myometrial junctional zone (J-zone) subendometrial layer, while noting that this layer’s organization and activity are not fully understood. The paper also reports mixed findings on how adenomyosis affects pregnancy outcomes and explicitly frames the field as evolving from older hypotheses that linked adenomyosis primarily to uterine interventions, parturition, or histologically confirmed endometriosis. This paper is centrally about adenomyosis — its specific focus is reviewing mechanisms underlying adenomyosis pathogenesis and diagnostic approaches, with discussion of the adenomyosis–endometriosis relationship.

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Abstract

Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility.
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Pathogenesis of adenomyosis - Authors: Orekhova E.K.1,2 - Affiliations: - ЕМС Ltd. - The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott - Issue: Vol 69, No 4 (2020) - Pages: 73-82 - Section: Reviews - Submitted: 13.03.2020 - Accepted: 23.06.2020 - Published: 28.09.2020 - URL: https://journals.eco-vector.com/jowd/article/view/25735 - DOI: https://doi.org/10.17816/JOWD69473-82 - ID: 25735 Cite item Abstract Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility. Full Text About the authors Ekaterina K. Orekhova ЕМС Ltd.; The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] MD; Post-Graduate Student (Applicant) Russian Federation, Saint PetersburgReferences - Письмо Минздрава России от 22 ноября 2013 № 15-4/10/ 2-8710 О направлении клинических рекомендаций «Эндометриоз: диагностика, лечение и реабилитация». [Letter from the Ministry of health of the Russian Federation No. 15-4/10/2-8710 O napravlenii klinicheskikh rekomendatsiy “Endometrioz: diagnostika, lecheniye i reabilitatsiya” dated 2013 November 22. (In Russ.)]. Доступно по: https://rulaws.ru/acts/Pismo-Minzdrava-Rossii-ot-22.11.2013-N-15-4_10_2-8710/. Ссылка активна 15.05.2020. - Leyendecker G, Bilgicyildirim A, Inacker M, et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet. 2015;291(4):917-932. https://doi.org/10.1007/s00404-014-3437-8. - Martínez-Conejero JA, Morgan M, Montesinos M, et al. Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation. Fertil Steril. 2011;96(4):943-950. https://doi.org/10.1016/ j.fertnstert.2011.07.1088. - Puente JM, Fabris A, Patel J, et al. Adenomyosis in infertile women: Prevalence and the role of 3D ultrasound as a marker of severity of the disease. Reprod Biol Endocrinol. 2016;14(1):60. https://doi.org/10.1186/s12958-016-0185-6. - Devlieger R, D’Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003;9(2):139-147. https://doi.org/10.1093/humupd/dmg010. - Печеникова В.А., Акопян Р.А., Кветной И.М. К вопросу о патогенетических механизмах развития и прогрессии внутреннего генитального эндометриоза ― аденомиоза // Журнал акушерства и женских болезней. – 2015. – Т. 64. – № 6. – С. 51‒57. [Pechenikova VA, Akopyan RA, Kvetnoy IM. Pathogenetic mechanisms of internal genital endometriosis – adenomyosis development and progression. Journal of obstetrics and women’s diseases. 2015;64(6):51-57. (In Russ.)] - Juang CM, Chou P, Yen MS, et al. Adenomyosis and risk of preterm delivery. BJOG. 2007;114(2):165-169. https://doi.org/10.1111/j.1471-0528.2006.01186.x. - Brosens I, Derwig I, Brosens J, et al. The enigmatic uterine junctional zone: The missing link between reproductive disorders and major obstetrical disorders? Hum Reprod. 2010;25(3):569-574. https://doi.org/10.1093/humrep/dep474. - Fusi L, Cloke B, Brosens JJ. The uterine junctional zone. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):479-491. https://doi.org/10.1016/j.bpobgyn.2006.02.001. - Werth R, Grusdew W. Untersuchungen über die Entwicklung und Morphologie der menschlichen Uterusmuskulatur. Arch Gynak. 1898;55:325-413. https://doi.org/10.1007/BF01981003. - Novellas S, Chassang M, Delotte J, et al. MRI characteristics of the uterine junctional zone: From normal to the diagnosis of adenomyosis. AJR Am J Roentgenol. 2011;196(5):1206-1213. https://doi.org/10.2214/AJR.10.4877. - Demas BE, Hricak H, Jaffe RB. Uterine MR imaging: Effects of hormonal stimulation. Radiology. 1986;159(1):123-126. https://doi.org/10.1148/radiology.159.1.3952297. - Wiczyk HP, Janus CL, Richards CJ, et al. Comparison of magnetic resonance imaging and ultrasound in evaluating follicular and endometrial development throughout the normal cycle. Fertil Steril. 1988;49(6):969-972. https://doi.org/10.1016/s0015-0282(16)59946-4. - Radiology Key [Internet]. Childs D, Dalrymple NC. Female Reproductive System. Chapter 21. Available from: https://radiologykey.com/female-reproductive-system/. - Bergeron C, Amant F, Ferenczy A. Pathology and physiology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):511-521. https://doi.org/10.1016/j.bpobgyn.2006.01.016. - Джемлиханова Л.Х., Смирнова М.Ю., Ниаури Д.А., Кветной И.М. Экспрессия рецепторов половых стероидных гормонов и факторов роста в миометрии при миоме матки и аденомиозе // Вестник Санкт-Петербургского университета. Медицина. – 2009. – № 4. – С. 222‒230. [Dzhemlikhanova LKh, Smirnova MYu, Niauri DA, Kvetnoy IM. Expression of receptors of sex steroid hormones and growth factors in miometrium in patients with uterine myoma and adenomyozis. Vestnik of Saint-Petersburg university. Medicine. 2009;(4):222-230. (In Russ.)] - Noe M, Kunz G, Herbertz M, et al. The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: Characterization of the endometrial-subendometrial unit. Hum Reprod. 1999;14(1):190-197. https://doi.org/10.1093/humrep/14.1.190. - Snijders MP, de Goeij AF, Debets-Te Baerts MJ, et al. Immunocytochemical analysis of oestrogen receptors and progesterone receptors in the human uterus throughout the menstrual cycle and after the menopause. J Reprod Fertil. 1992;94(2):363-371. https://doi.org/10.1530/jrf.0.0940363. - De Vries K, Lyons EA, Ballard G, et al. Contractions of the inner third of the myometrium. Am J Obstet Gynecol. 1990;162(3):679-682. https://doi.org/10.1016/0002-9378(90)90983-e. - Brosens IA. The utero-placental vessels at term − the distribution and extent of physiological changes. Placental Vascularization and Blood Flow. 1988;(3):61-67. - Kim YM, Bujold E, Chaiworapongsa T, et al. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2003;189(4):1063-1069. https://doi.org/10.1067/s0002-9378(03)00838-x. - Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: Tissue injury and repair. Arch Gynecol Obstet. 2009;280(4):529-538. https://doi.org/10.1007/s00404-009-1191-0. - McCausland AM. Hysteroscopic myometrial biopsy: Its use in diagnosing adenomyosis and its clinical application. Am J Obstet Gynecol. 1992;166(6 Pt 1):1619-1628. https://doi.org/10.1016/s0002-9378(11)91551-8. - Zhang Y, Yu P, Sun F, et al. Expression of oxytocin receptors in the uterine junctional zone in women with adenomyosis. Acta Obstet Gynecol Scand. 2015;94(4):412-418. https://doi.org/10.1111/aogs.12595. - Bazot M, Cortez A, Darai E, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: Correlation with histopathology. Hum Reprod. 2001;16(11):2427-2433. https://doi.org/10.1093/humrep/16.11.2427. - Fedele L, Bianchi S, Dorta M, et al. Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril. 1992;58(1):94-97. - Reinhold C, Atri M, Mehio A, et al. Diffuse uterine adenomyosis: Morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology. 1995;197(3):609-614. https://doi.org/10.1148/radiology.197.3.7480727. - Campo S, Campo V, Benagiano G. Adenomyosis and infertility. Reprod Biomed Online. 2012;24(1):35-46. https://doi.org/10.1016/j.rbmo.2011.10.003. - Тапильская Н.И., Гайдуков С.Н., Шанина Т.Б. Аденомиоз как самостоятельный фенотип дисфункции эндометрия // Эффективная фармакотерапия. – 2015. – № 5. – С. 62‒68. [Tapilskaya NI, Gaydukov SN, Shanina TB. Adenomyosis as a separate phenotype of endometrial dysfunction. Effektivnaya farmakoterapiya. 2015;(5):62-68. (In Russ.)] - Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: A systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374-392. https://doi.org/10.1093/humupd/dms006. - Agostinho L, Cruz R, Osório F, et al. MRI for adenomyosis: A pictorial review. Insights Imaging. 2017;8(6):549-556. https://doi.org/10.1007/s13244-017-0576-z. - Иващенко Т.Э., Голубева О.В., Швед Н.Ю., и др. Роль полиморфизма гена Р53 в патогенезе эндометриомы яичника // Журнал акушерства и женских болезней. – 2007. – T. 56. – № 2. – С. 55‒60. [Ivashhenko TE, Golubeva OV, Shved NYu, et al. Role of polymorphism of P53 gene in pathogenesis of ovarian endometriosis. Journal of obstetrics and women’s diseases. 2007;56(2):55-60. (In Russ).] - Сорокина А.В., Радзинский В.Е., Зиганшин Р.Х., Арапиди Г.П. Алгоритм диагностики аденомиоза с использованием неинвазивных методов исследования // Вестник национального медико-хирургического Центра им. Н.И. Пирогова. – 2011. – Т. 6. – № 1. – С. 124‒128. [Sorokina AV, Radzinsky VE, Ziganshin RKh, Arapidi GP. Algorithm of diagnosis of adenomyosis by non-invasive methods. Bulletin of Pirogov National Medical and Surgical Center. 2011;6(1):124-128. (In Russ.)] - Berkkanoglu M, Arici A. Immunology and endometriosis. Am J Reprod Immunol. 2003;50(1):48-59. https://doi.org/10.1034/j.1600-0897.2003.00042.x. - Голубева О.В., Иващенко Т.Э., Ниаури Д.А., и др. Генетические факторы предрасположенности к аденомиозу // Журнал акушерства и женских болезней. – 2007. – T. 56. – № 2. – С. 24‒30. [Golubeva OV, Ivashchenko TE, Niauri DA, et al. Geneticheskie faktory predraspolozhennosti k adenomiozu. Journal of obstetrics and women’s diseases. 2007;56(2):24-30. (In Russ.)] - Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol. 2005;3:28. https://doi.org/10.1186/1477-7827-3-28. - Tremellen KP, Russell P. The distribution of immune cells and macrophages in the endometrium of women with recurrent reproductive failure. II: adenomyosis and macrophages. J Reprod Immunol. 2012;93(1):58-63. https://doi.org/10.1016/j.jri.2011.12.001. - Khan KN, Kitajima M, Hiraki K, et al. Changes in tissue inflammation, angiogenesis and apoptosis in endometriosis, adenomyosis and uterine myoma after GnRH agonist therapy. Hum Reprod. 2010;25(3):642-653. https://doi.org/10.1093/humrep/dep437. - Salim R, Riris S, Saab W, et al. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod Biomed Online. 2012;25(3):273-277. https://doi.org/10.1016/j.rbmo.2012.05.003. - Harada T, Taniguchi F, Amano H, et al. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the japan environment and children’s study. PLoS One. 2019;14(8):e0220256. https://doi.org/10.1371/journal.pone.0220256.

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