Pathology and physiopathology of adenomyosis
Pathology and physiopathology of adenomyosis
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DOI：
10.1016/j.bpobgyn.2006.01.016
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发表时间：
2006-08-01
影响因子：
5.5
通讯作者：
Ferenczy, Alex
中科院分区：
文献类型：
--
作者：
Bergeron, Christine;Amant, Frederic;Ferenczy, Alex
子宫腺肌病的定义是子宫肌层内存在子宫内膜粘膜。这可能是由于基底部子宫内膜凹入子宫肌层所致。与相对高雌激素状态相关的基底膜的非周期、抗凋亡活性可能促进了内陷和子宫肌层内扩散的过程。大多数子宫腺肌病的病例是在月经过渡期(40-50岁)的经期妇女中发现的，这种情况与月经过多、痛经、子宫内膜息肉和子宫肌瘤有关。子宫内膜样腺癌常伴发子宫腺肌病，多为早期，组织学分级低，对激素敏感，预后良好。恶性生长扩展到子宫腺肌病的病灶对预后无不良影响。子宫切除术可明确诊断和治疗子宫腺肌病。虽然子宫腺肌病的子宫内膜腺对激素敏感，但外源性孕激素对子宫腺肌病的治疗无效。抗雌激素的达那唑和促性腺激素释放激素(GnRH)类似物可以抑制子宫腺肌病，但它们的使用必须是短期的。因此，手术切除是最好的治疗选择。
Adenomyosis is defined by the presence of endometrial mucosa within the myometrium. This probably occurs by invagination of the basalis endometrium into the myometrium. The process of invagination and intramyometrial spreading may be facilitated by the non-cyclic, anti-apoptotic activity of the basalis associated with relative hyper-oestrogenic states. Most cases of adenomyosis are discovered in multiparous women during the 'transitional' years (40-50 years), and the condition is associated with menorrhagia, dysmenorrhoea, endometrial polyps and leiomyomata uteri. Endometrioid adenocarcinoma is often associated with adenomyosis, is frequently of early stage and low histological grade, is hormone-sensitive, and has an excellent prognosis. Extension of malignant growth into foci of adenomyosis has no adverse effect on prognosis. Definite diagnosis and treatment of adenomyosis are obtained by hysterectomy. Although adenomyotic endometrial glands are hormone-sensitive, exogenous progestogenic agents are ineffective for the treatment of adenomyosis. Anti-oestrogenic danazol and gonadotrophin-releasing hormone (GnRH) analogues induce suppression of adenomyosis, but their use must be of short duration. Surgical extirpation, therefore, is the best therapeutic option.