Pathology and Pathogenesis of Adenomyosis

Maria Facadio Antero, Ayse Ayhan, A. Ayhan, James Segars, James H. Segars, Ie‐Ming Shih, Ie-Ming Shih
Seminars in reproductive medicine · 2020 · vol. 38(02/03) , pp. 108–118 · doi:10.1055/s-0040-1718922 · PMID:33080632 · W3093988083
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review summarizes the pathology and pathogenesis of adenomyosis, discussing conventional morphology and recent molecular studies while highlighting unmet needs in advancing its research.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper reviews the pathology and proposed pathogenesis of adenomyosis, focusing on how normal-appearing endometrial glands and stroma become located within the myometrium and thereby disrupt uterine smooth muscle function. It describes conventional histologic approaches used since the lesion’s initial descriptions over 150 years ago and discusses tissue-based molecular studies that may help clarify the tissue of origin, while also emphasizing that research progress has been hindered by nonstandardized tissue sampling and lack of consensus diagnostic criteria. A key stated caveat is that, compared with endometriosis, adenomyosis research has been incremental due to these pathology practice limitations, despite opportunities from advances in eutopic endometrium anatomy and biology. Relevance to endometriosis: the paper explicitly contrasts adenomyosis research progress with that of endometriosis and cites endometriosis-associated mechanisms as part of the broader context, though its main focus is adenomyosis pathology and pathogenesis.

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Abstract

Adenomyosis represents a unique pathophysiological condition in which normal-appearing endometrial mucosa resides within myometrium and is thus protected from menstrual shedding. The resulting ectopic presence of endometrial tissue composed of glands and stroma is thought to affect normal contractile function and peristalsis of uterine smooth muscle, causing menometrorrhagia, infertility, and adverse obstetric outcomes. Since the first description of adenomyosis more than 150 years ago, pathologists have studied this lesion by examining tissue specimens, and have proposed multiple explanations to account for its pathogenesis. However, as compared with endometriosis, progress of adenomyosis research has been, at best, incremental mainly due to the lack of standardized protocols in sampling tissue and a lack of consensus diagnostic criteria in pathology practice. Despite these limitations, recent advances in revealing the detailed anatomy and biology of eutopic endometrium offer an unprecedented opportunity to study this common but relatively understudied disorder. Here, we briefly summarize the pathological aspects of adenomyosis from an historical background, and discuss conventional morphology and recent tissue-based molecular studies with a special emphasis on elucidating its tissue of origin from a pathologist's perspective. We also discuss unmet needs in pathology studies that would be important for advancing adenomyosis research.

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Condition tags

mesh:D004715endometriosisadenomyosisinfertility

MeSH descriptors

Adenomyosis Endometrium Myometrium Adenomyosis Adenomyosis Adenomyosis Adenomyosis Disease Progression Endometriosis Endometriosis Endometrium Female History, 19th Century History, 20th Century Humans Myometrium

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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