**4. Pathology**

There are two types of adenomyosis: focal and diffuse. The typical uterus with adenomyosis is enlarged compared to normal ones. The thickening of the uterine

#### **Figure 1.**

*The thickening of the uterine well is made up of trabeculated areas, stippled or granular in appearance, with small yellow or darker cystic tissues which contain serous fluid or stale blood.*

**75**

*Adenomyosis*

*DOI: http://dx.doi.org/10.5772/intechopen.90942*

cyst (cystic adenomyosis) [12].

**5. Symptoms**

**Figure 2.**

**6. Diagnosis**

**6.1 Ultrasound sonography**

wall was made up of focal or diffused adenomyosis areas stippled or granular in appearance, with darker cystic lesions that may contain serous fluid or stale hemorrhage (**Figure 1**); in some rare cases, adenomyosis may present as a large chocolate

including glands and stroma cells within the myometrium (**Figure 2**).

*The presence of endometrial tissue, glands and stroma are within the myometrium.*

the uterus. Patients have associated leiomyomas [13] and endometriosis [14].

Some patients with adenomyosis have the history of infertility or abortion.

Imaging with transvaginal ultrasound (TVUS) can identify the subtle myometrial changes of adenomyosis, the findings may include: (1) the anterior or posterior myometrial wall appearing thicker, (2) small myometrial hypoechoic cysts, (3) endometrium JZ extending into the myometrium, (4) appearance of

The microscopic feature of adenomyosis is the presence of endometrial tissue

More than 80% of women with adenomyosis have some pathological process in

Early adenomyosis is asymptomatic, only about one-third of women with adenomyosis have symptoms. Secondary dysmenorrhea and menorrhagia are the common symptoms. The severity of dysmenorrhea correlates with the increasing number of invasions. It is thought to be caused by increased prostaglandin production found in adenomyosis tissues compared with normal myometrium. Approximately 60% of women suffer from abnormal uterine bleeding; menorrhagia and dysmenorrhea are the two major adenomyosis-associated symptoms, and 30% of patients with these symptoms have typical secondary, progressive dysmenorrhea [15]. Menorrhagia with adenomyosis includes excessively heavy or prolonged menstrual bleeding. Some patients' symptoms are not common but may include menstrual irregularities.

#### **Figure 2.**

*Endometriosis*

**74**

**Figure 1.**

*The thickening of the uterine well is made up of trabeculated areas, stippled or granular in appearance, with* 

the endometrium and myometrium is somehow attenuated. The most held theory regarding adenomyosis is the endometrial basalis layer invades through the end myometrial junctional zone (JZ) into the myometrium after trauma on the endometrium [3]. Estrogen and progesterone likely play a role in its development after invagination of the endometrium. Another theory is that adenomyosis is caused by metaplasia of the Müllerian tissue [4]. Ren et al. demonstrated that Belin 1 expression was decreased in eutopic endometrium, and negatively correlated with serum CA125 and pelvic pain. Belin 1, therefore, may play a role in the pathogenesis and progression of adenomyosis [5]. The tissue injury and repair (TIAR) mechanism is activated in response to tissue auto-traumatization. This mechanism leads to a specific physiological process that promoted local production of Bcl-2, and plays an important role in the occurrence and development of adenomyosis [6]. The levels of anti-smooth muscle antibody positive and collage I positive myofibroblasts are significantly higher in the JZ of women with adenomyosis than in those without [3], as the evidence of tissue microtrauma and activation of the TIAR mechanism.

Hyperestrogenism is suggested to result from increased local aromatization, and decreased local estrogen metabolism in the eutopic and ectopic endometrium of patients with adenomyosis. Hyperestrogenism may promote elevated mechanical strains and stresses that could injure cells in the junctional zone (JZ) [7, 8].

Recently, studies of embryonic pluripotent Müllerian remnants and differentiation of adult stem cells have also been reported [4, 9, 10]. Epithelial-mesenchymal transition (EMT) is biological process involved in embryological development, tissue repair, and cancer cell migration, but the mechanism triggering EMT in

There are two types of adenomyosis: focal and diffuse. The typical uterus with adenomyosis is enlarged compared to normal ones. The thickening of the uterine

*small yellow or darker cystic tissues which contain serous fluid or stale blood.*

adenomyosis has not yet been elucidated [11].

**4. Pathology**

*The presence of endometrial tissue, glands and stroma are within the myometrium.*

wall was made up of focal or diffused adenomyosis areas stippled or granular in appearance, with darker cystic lesions that may contain serous fluid or stale hemorrhage (**Figure 1**); in some rare cases, adenomyosis may present as a large chocolate cyst (cystic adenomyosis) [12].

The microscopic feature of adenomyosis is the presence of endometrial tissue including glands and stroma cells within the myometrium (**Figure 2**).

More than 80% of women with adenomyosis have some pathological process in the uterus. Patients have associated leiomyomas [13] and endometriosis [14].

#### **5. Symptoms**

Early adenomyosis is asymptomatic, only about one-third of women with adenomyosis have symptoms. Secondary dysmenorrhea and menorrhagia are the common symptoms. The severity of dysmenorrhea correlates with the increasing number of invasions. It is thought to be caused by increased prostaglandin production found in adenomyosis tissues compared with normal myometrium. Approximately 60% of women suffer from abnormal uterine bleeding; menorrhagia and dysmenorrhea are the two major adenomyosis-associated symptoms, and 30% of patients with these symptoms have typical secondary, progressive dysmenorrhea [15]. Menorrhagia with adenomyosis includes excessively heavy or prolonged menstrual bleeding. Some patients' symptoms are not common but may include menstrual irregularities. Some patients with adenomyosis have the history of infertility or abortion.
