THE SIGNIFICANCE OF PAIN IN LEIOMYOMA WITH ADENOMYOSIS AND LIOMYOMA WITHOUT ADENOMYSIS

T.A.A. Khalifa, Karima. S. Abidalla, Nural Al-Zail
In: Tobruk University Journal of Medical Sciences · 2023 · vol. 5(1) , pp. 63–69 · doi:10.64516/16d5az96 · W4412857457
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This study compared women with leiomyoma and adenomyosis to those with leiomyoma alone, finding pain is more prevalent in the former group.

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This retrospective study examined pain symptoms (dysmenorrhea, dyspareunia, and pelvic pain) in women undergoing hysterectomy for uterine leiomyoma, comparing those with concurrent adenomyosis on histopathology (97 total cases; 7 with adenomyosis, 90 without) to those with leiomyoma alone. The main finding was that pain was reported as an important symptom in both groups but was more prevalent in women whose hysterectomy specimens showed adenomyosis coexisting with leiomyoma, with a high proportion of symptoms correlating with histopathological adenomyosis. The authors’ main limitation is that the design is retrospective and relies on a small adenomyosis-containing subgroup (7 cases) from a single hospital over one year, limiting generalizability and precision. This paper is centrally about endometriosis and/or adenomyosis — it specifically evaluates adenomyosis coexisting with leiomyoma and how it relates to hysterectomy-associated pain patterns.

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Abstract

The pain represented as dysmenorrhea, dyspareunia and pelvic pain, which are common symptoms to leiomyoma and adenomyosis since these two disorders frequently occur concurrently. The study aimed to compare women undergoing hysterectomy with a pathological finding of both leiomyoma and adenomyosis to women with leiomyoma alone in relation to the clinical symptom of pain. identifying adenomyosis in women with leiomyoma will allow improved clinical decision-making regarding alternative to hysterectomy and likely a decreased risk of treatment failure. Methods: A retrospective study done at Salesi-hospital ANCONA (ITALY), The data collected from the patient files from January -2012 to December -2012. All operated patients for leiomyoma by hysterectomy was included. Result Our study sample comprised of 97 cases operated for leiomyoma by hysterectomy. From the 97 cases, there were 90 cases of leiomyoma without adenomyosis and 7 cases of leiomyoma with adenomyosis. Conclusion the pain is an important symptom of both leiomyoma uterus alone or leiomyoma with adenomyosis but present more in leiomyoma with adenomyosis in women undergoing hysterectomy, the pain commonly present more in patient with adenomyosis with leiomyoma and correlate in high percentage to the presence of adenomyosis on histopathological examination of specimen, so in cases of leiomyoma uterus adenomyosis must be expected as this affect the line of treatment.
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THE SIGNIFICANCE OF PAIN IN LEIOMYOMA WITH ADENOMYOSIS AND LIOMYOMA WITHOUT ADENOMYSIS DOI: https://doi.org/10.64516/16d5az96Keywords: Hysterectomy, Leiomyoma, Adenomyosis, Pain.Abstract The pain represented as dysmenorrhea, dyspareunia and pelvic pain, which are common symptoms to leiomyoma and adenomyosis since these two disorders frequently occur concurrently. The study aimed to compare women undergoing hysterectomy with a pathological finding of both leiomyoma and adenomyosis to women with leiomyoma alone in relation to the clinical symptom of pain. identifying adenomyosis in women with leiomyoma will allow improved clinical decision-making regarding alternative to hysterectomy and likely a decreased risk of treatment failure. Methods: A retrospective study done at Salesi-hospital ANCONA (ITALY), The data collected from the patient files from January -2012 to December -2012. All operated patients for leiomyoma by hysterectomy was included. Result Our study sample comprised of 97 cases operated for leiomyoma by hysterectomy. From the 97 cases, there were 90 cases of leiomyoma without adenomyosis and 7 cases of leiomyoma with adenomyosis. Conclusion the pain is an important symptom of both leiomyoma uterus alone or leiomyoma with adenomyosis but present more in leiomyoma with adenomyosis in women undergoing hysterectomy, the pain commonly present more in patient with adenomyosis with leiomyoma and correlate in high percentage to the presence of adenomyosis on histopathological examination of specimen, so in cases of leiomyoma uterus adenomyosis must be expected as this affect the line of treatment. Downloads References 1. Garcia, L. and Isaacson, k. (2011). Adenomyosis: review of the literature. J Minim Invasive Gynecol., 18(4): 428-37. DOI: https://doi.org/10.1016/j.jmig.2011.04.004 2. Parker, W. H. (2007). Etiology, symptomatology, and diagnosis of uterine myomas. Fertile Steril., 87(4): 725-36. 3. Tepleman, C., Marshall, S. F., Ursin, G., Horn- Ross, p. L., Clarke, C. A., Allen, M., Deapen, D., Ziogas, A., Reynolds, P., Cress, R., Anton-Culver, H., West, D., Ross, R. K. and Bernstein, L. (2008). Adenomyosis and endometriosis in the California Teachers Study. Fertile Steril., 90(2): 415-24. DOI: https://doi.org/10.1016/j.fertnstert.2007.06.027 4. Weiss, G., Maseelall, P., Schott, L. L., Brockwell, S. E., Schocken, M. and Johnston, J. M. (2009). Adenomyosis a variant, not a disease? evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertil Steril., 91(1):201-6. 5. Flake, G. P., Andersen, J. and Dixon, D. (2003). Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect., 111(8):1037-54. DOI: https://doi.org/10.1289/ehp.5787 6. Walker, C. L. and Stewart, E. A. (2005). Uterine fibroids: the elephant in the room. Science, 308(5728): 1589-92. DOI: https://doi.org/10.1126/science.1112063 7. Sheikh, H. and khan, K. S. (1990). Adenomyosis in Pakistani women: four year experience at the Aga khan University Medical Centre, Karachi. J Clin pathol., 43(10): 817-9. DOI: https://doi.org/10.1136/jcp.43.10.817 8. Bergholt, T., Eriksen, L., Berendt, N., Jacobsen, M. and Hertz, J. B. (2001). Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod., 16(11): 2418-21. DOI: https://doi.org/10.1093/humrep/16.11.2418 9. Weiss, G., Maseelall, P., Schott, L. L., Brockwell, S. E., Schocken, M. and Johnston, J. M. (2009). Adenomyosis a variant, not a disease? evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertil Steril., 91(1):201-6. DOI: https://doi.org/10.1016/j.fertnstert.2007.11.025 10. Spies, J. B., Bruno, J., Czeyda-Pommersheim, F., Magee, S. T., Ascher, S. A. and Jha, R. C. (2005). Long- term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol., 106(5 Pt 1): 933-939. DOI: https://doi.org/10.1097/01.AOG.0000182582.64088.84 11. Goodwin, S. C., Spies, J. B., Worthington-kirsch, R., Peterson, E., pron, G., Li, S. and Myers, E. R. (2008). Uterine artery embolization for treatment of leiomyomata: long- term outcomes from the fibroid Registry. Obstet Gynecol., 111(1): 22-33. DOI: https://doi.org/10.1097/01.AOG.0000296526.71749.c9 12. Parker, W. H. (2007). Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril., 87(4):725-36. DOI: https://doi.org/10.1016/j.fertnstert.2007.01.093 13. Marino, J. L., Eskenazi, B., Warner, M., Samuels, S., Vercellini, P., Gavoni, N. and Olive, D. (2004). Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study. Hum Reprod., 19(10): 2350-5. DOI: https://doi.org/10.1093/humrep/deh407 14. Yeniel, O., Cirpan, T., Ulukus, M., Ozbal, A., Gundem, G., Ozsener, S., Zekioglu, O. and Yilmaz,H. (2007). Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Cline Exp Obstet Gynecol., 34(3):163-7. 15. Fernandez, H. (2003). New concepts on pathophysiology, diagnosis and treatment of adenomyosis. J Gynecol Obstet Biol Reprod (Paris), 32(8 pt 2): 23-7. 16. Levgur, M. (2007). Therapeutic options for adenomyosis: a review. Arch Gynecol Obstet., 276(1):1-15. DOI: https://doi.org/10.1007/s00404-006-0299-8 17. 17-Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod. 2010 May;25(5):1177-82. doi: 10.1093/humrep/deq034. Epub 2010 Feb 22. PMID:20176591; PMCID: PMC2854044. DOI: https://doi.org/10.1093/humrep/deq034 18. 18-Pron G, Cohen M, Soucie J, Garvin G, Vanderburgh L, Bell S. The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life. Fertil Steril 2003; 79:112 – 119. DOI: https://doi.org/10.1016/S0015-0282(02)04539-9 19. 19-Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, Murray GD. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007;356:360 – 370. DOI: https://doi.org/10.1056/NEJMoa062003 Downloads Published Issue Section License Copyright (c) 2023 Taweda Khalifa, Karima. S. Abidalla, Nural.Al-Zail (Author) This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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adenomyosisdysmenorrheadyspareunia

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