Peculiarities of the clinical course and pathomorphological picture of ovarian endometriosis and adenomyosis in reproductive aged women

Authors

DOI:

https://doi.org/10.18370/2309-4117.2022.65.23-28

Keywords:

adenomyosis, endometriosis, infertility, treatment, histopathology

Abstract

Оbjectives: to assess the clinical and pathomorphological features of ovarian endometriosis and adenomyosis in women of reproductive age in order to determine possible causes of fertility disorders and ways to correct them.
Materials and methods. 87 patients were examined and divided into 2 groups. The first group included 45 (51.7%) patients with adenomyosis with or without concomitant pathology. The second group included 42 (48.3%) women with ovarian endometriomas. The control group consisted of 30 healthy women of childbearing age who were screened for male infertility.
Results. Clinical examination of the patients revealed a high frequency of gynecological (uterine fibroids, endometrial hyperplasia, infertility) and extragenital pathology. Obstetric and gynecological history was burdened by reproductive losses (involuntary and medical abortions, ectopic pregnancy), premature birth, preeclampsia, abnormal uterine and obstetric bleeding, and pelvic surgery. All patients underwent endoscopic treatment (laparoscopy, hysteroscopy). Morphological examination revealed features of the structure of endometrioid cysts, which explains the decrease in ovarian reserve, active adenomyosis, reactive hyperplasia and chronic endometritis, distortion of the uterine cavity by fibroids. This may play an important role in implantation and placentation.
Conclusions. Features of morphogenesis of ovarian endometrioma, found by us cystic and glandular-cystic forms may form the basis of endometrial microperforation pathogenesis, development of adhesions of the pelvic organs (in every third woman), ectopic pregnancy, fibrotic adjacent endometrioid tissue and reduction of ovarian reserve. The peculiarities of the uterus histostructure in adenomyosis, frequent combination with uterine fibroids, endometrial hyperplasia, chronic endometritis, ovarian endometriosis, deep infiltrative endometriosis, old age, aggravated obstetric anamnesis and the history of obstetric disorders may be related.

Author Biographies

I.Z. Hladchuk, Odesa National Medical University, Odesa

MD, professor, head of the Obstetrics and Gynecology Department

N.M. Rozhkovska, Odesa National Medical University, Odesa

MD, professor, Obstetrics and Gynaecology Department

V.O. Sytnikova, Odesa National Medical University, Odesa

MD, professor, Normal and Pathological Clinical Anatomy Department

I.V. Shpak, Odesa National Medical University; Maternity Hospital No. 5 of Odesa City Council, Odesa

MD, professor, Department of Obstetrics and Gynecology;
Director

S.M. Syvyi, Odesa National Medical University, Odesa

Assistant, Normal and Pathological Clinical Anatomy Department

References

  1. Bakun, O.V., Tkachuk, A.I. “Influence of genital endometriosis and concomitant diseases on infertility under the data of the retrospective analysis of case histories.” Bukovinian Medical Herald 4.92 (2019): 9–15.
  2. Vorobii, V.D. “Characteristcs of the course of pregnancy and labor in women with endometriosis.” Actual problems of modern medicine: Bulletin of the Ukrainian Medical Stomatological Academy 18.3 (63) (2018): 44–7.
  3. Zaporozhan, V.M., Gladchuk, I.Z., Rozhkovska, N.M., et al. “New technologies in surgical treatment of deep infiltrative and superficial peritoneal endometriosis.” Reproductive endocrinology 2.16 (2014): 7–9.
  4. Zaporozhan, V.M., Tatarchuk, T.P., Kaminskyi, V.V., et al. “National consensus on management patients with endometriosis.” Reproductive endocrinology 4.24 (2015): 7–12.
  5. Koval, G.D. “IL-17 in women with endometriosis combined with infertility.” Immunology and allergology: science and practice 1 (2013): 76–79.
  6. Medvedіev, M.V., Pokrovenko, D.A. “A modern view of the etiology, pathogenesis and diagnostic possibilities of external genital endometriosis (literature review).” Medical perspectives 24.1 (2019): 21–30. DOI: 10.26641/2307-0404.2019.1.162173
  7. Sytnikova, V.O., Rosha, L.H., Honcharenko, H.Y. “Clinical and morphological features of the course of internal endometriosis in combination with endometrioid carcinoma of the endometrium in postmenopausal women.” Science Review 3.2.9 (2018): 58–60.
  8. Acién, P., Velasco, I. “Endometriosis: a disease that remains enigmatic.” ISRN Obstet Gynecol 2013 (2013): 242149. DOI: 10.1155/2013/242149
  9. Agarwal, S.K., Chapron, C., Giudice, L.C., et al. “Clinical diagnosis of endometriosis: a call to action.” Am J Obstet Gynecol 4 (2019): 354–64.
  10. Amalinei, C., Păvăleanu, I., Lozneanu, L., et al. “Endometriosis – insights into a multifaceted entity.” Folia Histochem Cytobiol 1.2 (2018): 61–82. DOI: 10.5603/FHC.a2018.0013
  11. Augoulea, A., Alexandrou, A., Creatsa, M., et al. “Pathogenesis of endometriosis: the role of genetics, inflammation and oxidative stress.” Arch Gynecol Obstet 286.1 (2012): 99–103. DOI: 10.1007/s00404-012-2357-8
  12. Brosens, I., Gordts, S., Benagiano, G. “Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion.” Hum Reprod 28 (2013): 2026–31.
  13. Cakmak, H., Guzeloglu-Kayisli, O., Kayisli, U.A., Arici, A. “Immune-endocrine interactions in endometriosis.” Front Biosci (Elite Ed) 1 (2009): 429–43.
  14. Zondervan, K.T., Becker, C.M., Missmer, S.A. “Endometriosis.” N Engl J Med 382.13 (2020): 1244–56. DOI: 10.1056/NEJMra1810764
  15. Cranney, R., Condous, G., Reid, S. “An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma.” Acta Obstet Gynecol Scand 96 (2017): 633–43. DOI: 10.1111/aogs.13114
  16. Dahiya, A., Sebastian, A., Thomas, A., et al. “Endometriosis and malignancy: The intriguing relationship.” Int J Gynaecol Obstet 155.1 (2021): 72–8. DOI: 10.1002/ijgo.13585
  17. ESHRE. “ESHRE guideline: endometriosis.” Hum Reprod Open 2022.2 (2022): hoac009. DOI: 10.1093/hropen/hoac009
  18. Fang, Z., Yang, S., Lydon, J.P., et al. “Intact progesterone receptors are essential to counteract the proliferative effect of estradiol in a genetically engineered mouse model of endometriosis.” Fertil Steril 82.3 (2004): 673–8. DOI: 10.1016/j.fertnstert.2004.01.048
  19. Guerriero, S., Condous, G., van den Bosch, T., et al. “Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group.” Ultrasound Obstet Gynecol 48.3 (2016): 318–32.
  20. Giudice, L.C. “Clinical practice. Endometriosis.” N Engl J Med 362.25 (2010): 2389–98. DOI: 10.1056/NEJMcp1000274
  21. Johnson, N.P., Hummelshoj, L., Adamson, G.D., et al. “World Endometriosis Society consensus on the classification of endometriosis.” Hum Reprod 32.2 (2017): 315–24.
  22. Khan, K.N., Kitajima, M., Inoue, T., et al. “17β-estradiol and lipopolysaccharide additively promote pelvic inflammation and growth of endometriosis.” Reprod Sci 22.5 (2015): 585–94. DOI: 10.1177/1933719114556487
  23. Macer, M.L., Taylor, H.S. “Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility.” Obstet Gynecol Clin North Am 39.4 (2012): 535–49. DOI: 10.1016/j.ogc.2012.10.002
  24. Martire, F.G., Lazzeri, L., Conway, F., et al. “Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis.” Fertil Steril 114.5 (2020): 1049–57.
  25. Menakaya, U., Reid, S., Lu, C., et al. “Performance of an Ultrasound Based Endometriosis Staging System (UBESS) for predicting the level of complexity of laparoscopic surgery for endometriosis.” Ultrasound Obstet Gynecol 48 (2016): 786–95.
  26. Mikos, T., Lioupis, M., Anthoulakis, C., Grimbizis, G.F. “The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis.” J Minim Invasive Gynecol 27 (2020): 309.
  27. Robboy, S.J., Bean, S.M. “Pathogenesis of endometriosis.” Reprod Biomed Online 21.1 (2010): 4–5. DOI: 10.1016/j.rbmo.2010.03.031
  28. Rolla, E. “Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment.” F1000Research 8 (2019): F1000 Faculty Rev-529. DOI: 10.12688/f1000research.14817.1
  29. Rozhkovskaya, N.M., Sitnikova, V.O., Sivyi, S.M., Lomakina, I.S. “Clinical and morphological features of combined hyperplastic diseases of the uterus against the background of adenomyosis.” Journal of education health and sport 10.4 (2020): 226–33. DOI: 10.12775/JEHS.2020.10.04.025
  30. Singh, S.S., Suen, M.W. “Surgery for endometriosis: beyond medical therapies.” Fertil Steril 107.3 (2017): 549–54. DOI: 10.1016/j.fertnstert.2017.01.001
  31. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11). Geneva: WHO (2018).
  32. Wu, Q., Lian, Y., Chen, L., et al. “Alleviation of Symptoms and Improvement of Endometrial Receptivity Following Laparoscopic Adenomyoma Excision and Secondary Therapy with the Levonorgestrel-releasing Intrauterine System.” Reprod Sci 27.6 (2020): 1259–65.

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Published

2022-08-09

How to Cite

Hladchuk, I., Rozhkovska, N., Sytnikova, V., Shpak, I., & Syvyi, S. (2022). Peculiarities of the clinical course and pathomorphological picture of ovarian endometriosis and adenomyosis in reproductive aged women. REPRODUCTIVE ENDOCRINOLOGY, (65), 23–28. https://doi.org/10.18370/2309-4117.2022.65.23-28

Issue

No. 65 (2022)

Section

Uroginecology

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Copyright (c) 2022 І.З. Гладчук, Н.М. Рожковська, В.О. Ситнікова, І.В. Шпак, С.М. Сивий

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