Sonographic Assessment of Uterine Fibroids and Adenomyosis

In: Gynaecological Ultrasound Scanning · 2020 · pp. 41–68 · doi:10.1017/9781108149877.004 · W3007848790
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Uterine fibroids, common benign tumors, can cause various symptoms and complications but rarely undergo malignant degeneration.

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This chapter in Gynaecological Ultrasound Scanning describes how uterine fibroids (leiomyomas) and adenomyosis are assessed with gynecologic ultrasound, outlining their defining features, common symptom associations, patterns of number and location, and relevant degenerative and (rare) malignant changes. It summarizes practical ultrasound imaging considerations by presenting key concepts and referencing comparative diagnostic approaches (including MRI and histologic correlations) used to interpret fibroid and adenomyosis findings, with an explicit caveat that malignant transformation is extremely rare. A limitation is that the provided text is a descriptive educational overview rather than a single original study with patient-level methods or results. This paper is centrally about endometriosis and/or adenomyosis — it includes a dedicated chapter section on sonographic assessment of adenomyosis, a condition closely related to endometriosis in the corpus context.

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Abstract

Uterine fibroids (or leiomyomas) are the most common benign gynaecological tumours, formed by smooth muscle and connective tissue. Most are asymptomatic, but sometimes may cause pain, pressure symptoms, metrorrhagia, infertility due to implantation failure, miscarriage, preterm delivery, and puerperal haemorrhage. Fibroids can be single or multiple. Their size and location vary and they may undergo benign degenerative changes: atrophic and hyaline degeneration, calcification, infection, and infarction. Malignant degeneration towards leiomyosarcoma is extremely rare, occurring in less than 0.2 per cent of cases.
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- Gynaecological Ultrasound Scanning - Gynaecological Ultrasound Scanning - Copyright page - Contents - Contributors - Chapter 1 Get to Know Your Machine and Scanning Environment - Chapter 2 Baseline Sonographic Assessment of the Female Pelvis - Chapter 3 Difficult Gynaecological Ultrasound Examination - Chapter 4 Sonographic Assessment of Uterine Fibroids and Adenomyosis - Chapter 5 Sonographic Assessment of Congenital Uterine Anomalies - Chapter 6 Sonographic Assessment of Endometrial Pathology - Chapter 7 Sonographic Assessment of Polycystic Ovaries - Chapter 8 Sonographic Assessment of Ovarian Cysts and Masses - Chapter 9 Sonographic Assessment of Pelvic Endometriosis - Chapter 10 Sonographic Assessment of Fallopian Tubes and Tubal Pathologies - Chapter 11 Role of Ultrasound in Assisted Reproductive Treatment - Chapter 12 Operative Ultrasound in Gynaecology - Chapter 13 Sonographic Assessment of Complications Related to Assisted Reproductive Techniques - Chapter 14 Sonographic Assessment of Early Pregnancy - Chapter 15 Tips and Tricks when Using Ultrasound in a Contraception Clinic - Chapter 16 Doppler Ultrasound in Gynaecology - Index - References Published online by Cambridge University Press: 28 February 2020 Book contents - Gynaecological Ultrasound Scanning - Gynaecological Ultrasound Scanning - Copyright page - Contents - Contributors - Chapter 1 Get to Know Your Machine and Scanning Environment - Chapter 2 Baseline Sonographic Assessment of the Female Pelvis - Chapter 3 Difficult Gynaecological Ultrasound Examination - Chapter 4 Sonographic Assessment of Uterine Fibroids and Adenomyosis - Chapter 5 Sonographic Assessment of Congenital Uterine Anomalies - Chapter 6 Sonographic Assessment of Endometrial Pathology - Chapter 7 Sonographic Assessment of Polycystic Ovaries - Chapter 8 Sonographic Assessment of Ovarian Cysts and Masses - Chapter 9 Sonographic Assessment of Pelvic Endometriosis - Chapter 10 Sonographic Assessment of Fallopian Tubes and Tubal Pathologies - Chapter 11 Role of Ultrasound in Assisted Reproductive Treatment - Chapter 12 Operative Ultrasound in Gynaecology - Chapter 13 Sonographic Assessment of Complications Related to Assisted Reproductive Techniques - Chapter 14 Sonographic Assessment of Early Pregnancy - Chapter 15 Tips and Tricks when Using Ultrasound in a Contraception Clinic - Chapter 16 Doppler Ultrasound in Gynaecology - Index - References Uterine fibroids (or leiomyomas) are the most common benign gynaecological tumours, formed by smooth muscle and connective tissue. Most are asymptomatic, but sometimes may cause pain, pressure symptoms, metrorrhagia, infertility due to implantation failure, miscarriage, preterm delivery, and puerperal haemorrhage. Fibroids can be single or multiple. Their size and location vary and they may undergo benign degenerative changes: atrophic and hyaline degeneration, calcification, infection, and infarction. Malignant degeneration towards leiomyosarcoma is extremely rare, occurring in less than 0.2 per cent of cases. - Type - Chapter - Information - Gynaecological Ultrasound ScanningTips and Tricks, pp. 41 - 68Publisher: Cambridge University PressPrint publication year: 2020 Schwartz, PE, Kelly, MG. Malignant transformation of myomas: myth or reality? Obstet Gynecol Clin North Am 2006;33(1):183–98.Google Scholar Bulletti, C, Coccia, ME, Battistoni, S, Borini, A. Endometriosis and infertility. J Assist Reprod Genet 2010;27(8):441–7.Google Scholar Benaglia, L, Cardellicchio, L, Leonardi, M, et al. Asymptomatic adenomyosis and embryo implantation in IVF cycles. Reprod Biomed Online 2014;29(5):606–11.CrossRefGoogle ScholarPubMed Vercellini, P, Consonni, D, Dridi, D, et al. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod 2014;29(5):964–77.Google Scholar Tremellen, K, Thalluri, V. Impact of adenomyosis on pregnancy rates in IVF treatment. Reprod Biomed Online 2013;26(3):299–300.Google Scholar Salim, R, Riris, S, Saab, W, et al. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod Biomed Online 2012;25(3):273–7.Google Scholar 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):374–92.Google Scholar Pritts, E, Parker, W, Olive, D. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009;91:1215–23.CrossRefGoogle ScholarPubMed Ivo Brosens, I, Kunz, G., Benagiano, G. Is adenomyosis the neglected phenotype of an endomyometrial dysfunction syndrome? Gynecol Surg 2012;9(2):131–7.Google Scholar Dueholm, M, Lundorf, E, Hansen, ES, Ledertoug, S, Olesen, F. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril 2001;76:350–7.Google Scholar Munro, MG, Critchley, HO, Fraser, IS, FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011;95(7):2204–8.CrossRefGoogle ScholarPubMed Wamsteker, K, Emanuel, MH, de Kruif, JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993;82:736–40Google ScholarPubMed Lasmar, RB, Xinmei, Z, Indman, PD, Celeste, RK, Di Spiezio Sardo, A. Feasibility of a new system of classification of submucous myomas: a multicenter study. Fertil Steril 2011;95(6):2073–7.Google Scholar Mavrelos, D, Naftalin, J, Hoo, W, et al. Preoperative assessment of submucous fibroids by three-dimensional saline contrast sonohysterography. Ultrasound Obstet Gynecol 2011;38:350–4.CrossRefGoogle ScholarPubMed Mohan, P, Hamblin, M, Vogelzang, RU. Artery embolization and its effect on fertility. J Vasc Interv Radiol 2013;24:925–30.Google Scholar Qidwai, IG, Caughey, AB, Jacoby, AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006;107:376–82.Google Scholar Laughlin, SK, Herring, AH, Savitz, DA, et al. Pregnancy-related fibroid reduction. Fertil Steril 2010;94:2421–3.CrossRefGoogle ScholarPubMed Reinhold, C, Tafazoli, F, Mehio, A, et al. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 1999;19:S147–60.Google Scholar Fedele, L, Bianchi, S, Dorta, M, et al. Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril 1992;58:94–7.CrossRefGoogle ScholarPubMed Jayaprakasan, K, Panchal, S. Ultrasound in Subfertility: Routine Applications and Diagnostic Challenges. Jaypee Brothers Medical Publishers, 2014.Google Scholar Ludwin, A, Ludwin, I, Kudla, M, et al. Diagnostic accuracy of three-dimensional sonohysterography compared with office hysteroscopic and its interrater/intrarater agreement in uterine cavity assessment after hysterocopicmetroplasty. Fertil Steril 2014;101(5)1392–9.CrossRefGoogle Scholar Exacoustos, C, Brienza, L, Di Giovanni, A, et al. Adenomyosis: three dimensional sonographic findings of the junction zone and correlation with histology. Ultrasound Obstet Gynecol 2011;37(4):471–9.Google Scholar Luciano, DE, Exacoustos, C, Albrecht, L, et al. Three-dimensional ultrasound in diagnosis of adenomyosis: histologic correlation with ultrasound targeted biopsies of the uterus. J Minim Invasive Gynecol 2013;20(6):803–10.Google Scholar Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. 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adenomyosisinfertility

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