Junctional zone thickening: an endo-myometrial unit disorder

S Gordts, Stephan Gordts, Grigoris Grimbizis, G Grimbizis, V Tanos, Vasilios Tanos, P Koninckx, Philippe R. Koninckx, R Campo
Facts, views & vision in ObGyn · 2023 · vol. 15(4) , pp. 309–316 · doi:10.52054/fvvo.15.4.109 · PMID:38128089 · W4390120308
article OA: bronze CC0 ⤵ 6 in-corpus citations
📄 Open PDF View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Thickening of the junctional zone, identified as an endo-myometrial unit disorder, is a distinct entity separate from myometrial pathology impacting fertility and pregnancy outcomes.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper discusses how adenomyosis is defined and classified, emphasizing that histopathology based on hysterectomy specimens has been challenged, while MRI and 2D/3D ultrasound enabled adenomyosis to become a clinical entity. It reviews imaging spectrum descriptions, including junctional zone (JZ) thickening and various patterns of uterine wall involvement, and highlights that the sub-endometrial halo is a distinct entity based on nuclear density and vascular structure. The authors propose that JZ thickening reflects an inner myometrium adenomyosis concept (with or without endometrial invasion) and argue that changes in the JZ represent a different entity from myometrial alterations linked to reproductive, bleeding, pain, and obstetric outcomes, with basal endometrium and JZ pathology termed an endo-myometrial unit disorder (EMUD). The paper’s limitation is that it is a narrative argument addressing disagreement in definitions and terminology rather than presenting original empirical data. This paper is centrally about adenomyosis — it focuses on junctional zone thickening and reframes related pathology as an endo-myometrial unit disorder.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Adenomyosis is a disease defined by histopathology, mostly of hysterectomy specimens, and classification is challenged by the disagreement of the histologic definition. With the introduction of Magnetic Resonance Imaging (MRI) and two- and three-dimensional ultrasound, the diagnosis of adenomyosis became a clinical entity. In MRI and US, adenomyosis ranges from thickening of the inner myometrium or junctional zone to nodular, cystic, or diffuse lesions involving the entire uterine wall, up to a well-circumscribed adenomyoma or a polypoid adenomyoma. The absence of an accepted classification and the vague and inconsistent terminology hamper basic and clinical research. The sub-endometrial halo seen at US and MRI is a distinct entity, differing from the outer myometrium by its increased nuclear density and vascular structure. The endometrium and the sub-endometrial muscularis or archimetra are of Müllarian origin, while the outer myometrium is non-Mullerian mesenchymal. The junctional zone (JZ) is important for uterine contractions, conception, implantation, and placentation. Thickening of the JZ can be considered inner myometrium adenomyosis, with or without endometrial invasion. Changes in the JZ should be considered a different entity than myometrial clinically associated with impaired conception, implantation, abnormal uterine bleeding, pelvic pain and obstetrical outcome. Pathology of the basal endometrium and JZ is a separate entity and should be identified as an endo-myometrial unit disorder (EMUD).

My notes (saved in your browser only)

Condition tags

adenomyosis

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.

References (67)

Cited by (6)

Source provenance

europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-22T00:33:21.010913+00:00
License: CC0 · commercial use OK