Distinct types of uterine adenomyosis based on laparoscopic and histopathologic criteria

George Pistofidis, G Pistofidis, E Makrakis, Evangelos Makrakis, O Koukoura, Ourania Koukoura, N Bardis, N.S. Bardis, P Balinakos, P.M. Balinakos, Vincent Anaf, V Anaf
Clinical and experimental obstetrics & gynecology · 2014 · vol. 41(2) , pp. 113–118 · doi:10.12891/ceog16152014 · PMID:24779231 · W1517170784
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This study identified four laparoscopic and histopathologic types of adenomyosis—diffuse, sclerotic, nodular, and cystic—which differed in presenting symptoms and surgical treatment approach.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The study analyzed 68 women treated laparoscopically for uterine adenomyosis at a referral gynecologic laparoscopy center, comparing intraoperative laparoscopic findings with histopathology to classify adenomyosis into four types. The authors identified diffuse, sclerotic, nodular, and cystic adenomyosis (54.5%, 13%, 28%, and 4.5%), and found menorrhagia as the main presenting symptom was significantly more frequent in diffuse cases (84%) than in sclerotic (44%) and nodular (37%) cases. Treatment approaches differed by type, with cystic and nodular adenomyosis managed by laparoscopic excision, sclerotic cases most often treated with wide excision, and diffuse cases predominantly treated with laparoscopic hysterectomy. This paper is centrally about adenomyosis — it proposes four adenomyosis types based on laparoscopic and histopathologic criteria and links them to symptoms and surgical approach.

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Abstract

PURPOSE: 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. MATERIALS AND 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.
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Abstract

Purpose: 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. Materials and Methods: Sixtyeight 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 and p = 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.

Keywords

- Adenomyosis - Laparoscopy - Laparoscopic adenomyomectomy - Laparoscopic hysterectomy

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Condition tags

dysmenorrheachronic_pelvic_painadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Laparoscopy Adenomyosis Adenomyosis Adult Age Factors Dysmenorrhea Dysmenorrhea Female Humans Hysterectomy Leiomyoma Leiomyoma Leiomyoma Menorrhagia Menorrhagia Middle Aged Myometrium Myometrium

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