Vascular Involvement in Adenomyosis: Report of a Large Series of a Common Phenomenon With Observations on the Pathogenesis of Adenomyosis

Meenakshi M, Meenakshi Meenakshi, McCluggage WG, W. Glenn McCluggage
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2010 · vol. 29(2) , pp. 117–121 · doi:10.1097/pgp.0b013e3181b7018d · PMID:20173497 · W2054135016
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This study examined 434 uteri with adenomyosis, finding vascular involvement in 12.4% of cases, primarily consisting of endometrial stroma, suggesting a perivascular origin for adenomyosis.

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This study analyzed a large series of 434 uteri with adenomyosis to investigate the prevalence and characteristics of vascular involvement. Vascular invasion was identified in 12.4% of cases, typically presenting as intravascular endometrial stroma or glands protruding beneath an intact endothelial lining. The authors note that this phenomenon is relatively common and can mimic neoplastic processes, suggesting a potential pathogenesis involving multipotential perivascular cells. This paper is centrally about adenomyosis — specifically detailing the frequency and histological features of vascular involvement within the condition.

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Abstract

The occurrence of vascular involvement in adenomyosis has been noted earlier, but there has been little detailed study of this phenomenon. In this study, we examined a large series of uteri with adenomyosis (n=434), specifically looking for the presence of adenomyotic foci within vascular channels. Vascular involvement was identified in 54 cases (12.4%). In 19 of 54 cases (35%) a single vessel was involved, in 16 cases (30%) 2 to 3 vessels, and in 19 cases (35%) multiple vessels. In 34 cases (63%), the intravascular component comprised endometrial stroma only and in 20 cases (37%) there was a mixture of glands and stroma, although even in these cases some of the individual foci exhibiting vascular involvement consisted of stroma only. In most cases, the intravascular component protruded into the vessel lumen beneath an intact endothelial lining. Immunohistochemistry performed in a small number of cases confirmed the intravascular location and showed the intravascular tissue to be lined on the luminal surface with endothelial cells. Pathologists should be aware of the phenomenon of vascular involvement in adenomyosis, which is relatively common and, when widespread, may result in the consideration of a neoplastic process. The pattern of vascular involvement raises the possibility that adenomyosis develops from cells intimately associated with myometrial blood vessels, perhaps multipotential perivascular cells.
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Vascular Involvement in Adenomyosis: Report of a Large Series of a Common Phenomenon With Observations on the Pathogenesis of Adenomyosis - Meenakshi Meenakshi - W. Glenn McCluggage The occurrence of vascular involvement in adenomyosis has been noted earlier, but there has been little detailed study of this phenomenon. In this study, we examined a large series of uteri with adenomyosis (n=434), specifically looking for the presence of adenomyotic foci within vascular channels. Vascular involvement was identified in 54 cases (12.4%). In 19 of 54 cases (35%) a single vessel was involved, in 16 cases (30%) 2 to 3 vessels, and in 19 cases (35%) multiple vessels. In 34 cases (63%), the intravascular component comprised endometrial stroma only and in 20 cases (37%) there was a mixture of glands and stroma, although even in these cases some of the individual foci exhibiting vascular involvement consisted of stroma only. In most cases, the intravascular component protruded into the vessel lumen beneath an intact endothelial lining. Immunohistochemistry performed in a small number of cases confirmed the intravascular location and showed the intravascular tissue to be lined on the luminal surface with endothelial cells. Pathologists should be aware of the phenomenon of vascular involvement in adenomyosis, which is relatively common and, when widespread, may result in the consideration of a neoplastic process. The pattern of vascular involvement raises the possibility that adenomyosis develops from cells intimately associated with myometrial blood vessels, perhaps multipotential perivascular cells.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Endometrium Myometrium Uterine Diseases Adult Antigens, CD34 Antigens, CD34 Blood Vessels Blood Vessels Endometriosis Endometrium Female Humans Immunohistochemistry Middle Aged Myometrium Platelet Endothelial Cell Adhesion Molecule-1 Platelet Endothelial Cell Adhesion Molecule-1 Retrospective Studies Uterine Diseases

Citation neighborhood

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