Adenomyosis Flashcards Preview

B - Gynaecology > Adenomyosis > Flashcards

Flashcards in Adenomyosis Deck (42)
1

What is adenomyosis?

The presence of functional endometrial tissue within the myometrium of the uterrus

2

Which layer of the uterine wall is invaded by endometrium in adenomyosis?

Middle layer

3

What is the relationships between adenomyosis and endometriosis?

Adenomyosis has been described as a variant of endometriosis, but although the conditions can occur together, they are distinct diagnoses

4

How common is adenomyosis in hysterectomy specimens?

It is found in up to 40% of hysterectomy specimens

5

What is the pathophysiology of adenomyosis?

It is thought to occur when the endometrial stroma is allowed to communicate with the underlying myometrium after uterine damage

6

What is the endometrial stroma?

Connective/supporting tissue

7

What might cause interaction between the underlying myometrium and the endometrial stroma?

- Pregnancy and childbirth
- C-section
- Uterine surgery
- Surgical management of miscarriage or termination of pregnancy

8

Give an example of a uterine surgery that might allow the interaction of myometrium and endometrial stroma

Endometrial curettage

9

Is the invasion of endometrium focal or diffusion in adenomyosis?

Can be either

10

Where is invasion of endometrium in adenomyosis most commonly found?

In the posterior wall of the uterus

11

How extensive is the invasion of endometrium in adenomyosis?

Variable

12

What can happen in severe cases of adenomyosis?

Pockets of menstrual blood can be seen in the myometrium of the hysterectomy specimens

13

What is an adenomyoma?

When a collection of endometrial glands form grossly visible nodules

14

What receptors are found in the ectopic endometrial tissue in adenomyosis?

Oestrogen, progesterone, and androgen receptors

15

What is the result of oestrogen, progesterone, and androgen receptors being found in the endometrial tissue in adenomyosis?

Makes it responsive to hormones

16

What are the risk factors for adenomyosis?

- High parity
- Uterine surgery
- Previous C-section
- Family history

17

Give 2 examples of uterine surgery that increase the risk of adenomyosis

- Endometrial curettage
- Endometrial ablation

18

What are the main presenting symptoms of adenomyosis?

- Menorrhagia
- Dysmenorrhoea
- Deep dyspareunia
- Irregular bleeding

19

Describe the dysmenorrhoea in adenomyosis

It is commonly progressive, beginning as cyclical pain but can worsen to daily pain

20

What may be found on examination in adenomyosis?

Symmetrically enlarged tender uterus

21

What are the differential diagnoses for adenomyosis?

- Endometriosis
- Fibroids
- Endometrial hyperplasia/endometrial carcinoma
- Endometrial polyps
- Pelvic inflammatory disease
- Hypothyroidism and coagulation disorders

22

How is the definitive diagnosis of adenomyosis made?

Histological diagnosis after hysterectomy

23

What recent advances have there been in the diagnosis of adenomyosis?

Advances in histological diagnosis from specimens obtained at hysteroscopic biopsy

24

What can assist the diagnosis of adenomyosis in clinically suspected cases?

Imaging

25

What imaging is used in adenomyosis?

- Transvaginal ultrasound
- MRI

26

What is the limitation of transvaginal ultrasound in adenomyosis?

Highly observer dependant

27

What are the signs of adenomyosis on transvaginal ultrasound?

- Globular uterine configuration
- Poor definition of the endometrial-myometrial interface
- Myometrial anterior-posterior asymmetry
- Intramyometrial cysts
- Heterogenous myometrial echo texture

28

What does MRI show in adenomyosis?

'Endo-myometrial junctional zone' that can be distinguished from the endometrium and outer myometrium

29

What is recognised as a hallmark of adenomyosis on MRI?

Irregular thickening of the endometrial junction

30

What is the main aim of the management of adenomyosis?

Control dysmenorrhoea and menorrhagia

31

What is the only curative therapy for adenomyosis at present?

Hysterectomy

32

What are the more conservative approaches aimed at symptom control in adenomyosis?

- Analgesia
- Hormone therapy
- Non-hormone treatments

33

What analgesics are used in adenomyosis?

NSAIDs

34

What hormone therapies are available for the management of adenomyosis?

- Combined oral contraceptives
- Progestogens
- Gonadotrophin releasing hormone agonists
- Aromatase inhibitors

35

How can progesterones be administered in adenomyosis?

- Oral
- intrauterine system. e.g. Mirena

36

What is the purpose of hormonal therapy in adenomyosis?

Reduction of bleeding and cycle control

37

How do hormonal therapies work in adenomyosis?

Proposed that hormones reduce the proliferation of the ectopic endometrial cells, therefore reducing their mass and subsequently decreasing uterine size and volume of blood lost

38

What can temporarily induce the regression of adenomyosis?

Continuous combined oral contraceptive and high dose progestins, e.g. SC depot medroxyprogesterone

39

What are the non-hormonal treatments available in adenomyosis?

- Hysterectomy
- Uterine artery embolism
- Endometrial ablation and resection
- Laparoscopic excision
- MR-guided focused ultrasound

40

Is uterine embolism a long or short term management option for adenomyosis?

Short and medium

41

Who is uterine artery embolism a good option for in adenomyosis?

Women who wish to avoid hysterectomy and/or preserve their fertility

42

What is the aim of uterine artery embolism in adenomyosis?

Block blood supply to the adenomyosis, causing it to shrink