Archimetra: imaging aspects of combined pathology of the endometrium and myometrium
DOI:
https://doi.org/10.18370/2309-4117.2023.67.74-78Keywords:
combined pathology, endometrium, myometrium, visualization, endometrial-myometrial junctionAbstract
Objectives: evaluation of changes in the endometrial-myometrial junction (EMJ) in the combined pathology of the endometrium and myometrium.
Materials and methods. 50 perimenopausal women with combined pathology of the endometrium and myometrium (main group) were examined. The control group consisted of 30 practically healthy women of the same age who were examined for the male factor of infertility. All patients underwent a comprehensive examination, which included clinical and paraclinical research methods.
Patients were examined using transvaginal ultrasound. The DEERS (Diseases of Endometrium – Evaluation and Risk scoring System) index was used for the integral assessment of the endometrium and myometrium state.
Results. The average age of women was 43.4 ± 1.2 years. The combination of endometrial hyperplasia (EH) and intramural uterine myoma was found in 58.0% of cases, EH and submucous uterine myoma – in 14.0%, EH and endometrial polyps – in 10.0%, EH and external peritoneal endometriosis – in 12.0%, EH and adenomyosis – in 4.0%, EH, adenomyosis and uterine fibroids – in 2.0%.
The blood flow rate in the uterine arteries in the main group was 38.8 ± 0.6 cm/s, resistance index – 0.8 ± 0.04, pulsation index – 1.3 ± 0.1. In the control group the blood flow rate in the uterine arteries was 42.2 ± 0.8 cm/s without a clear difference of the sides, the resistance index – 0.9 ± 0.1, the pulsation index – 1.2 ± 0.1 (p > 0.05).
The total DEERS score in the main group was 13.2 ± 0.4 points, in the control group it was 7.3 ± 0.7 points. In the vast majority of cases (88.0%) EMJ was not involved in the pathological process. The average thickness of the EMJ in women from the control group was 0.45 ± 0.05 cm, in the main group – 0.42 ± 0.03 cm. At the same time, 36 (72.0%) women with combined pathology of the endometrium and myometrium had signs of hypomobility EMJ.
Conclusions. EMJ was not involved in the pathological process in the vast majority of patients with combined pathology of the endometrium and myometrium. At the same time, some women with combined pathology of the endometrium and myometrium showed signs of hypomobility of the EMJ.
References
- Tanos, V., Balami, S., Lingwood, L. “Junctional zone endometrium alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment.” Curr Opin Obstet Gynecol 31.6 (2019): 418–27. DOI: 10.1097/GCO.0000000000000572. PMID: 31573995.
- Novellas, S., Chassang, M., Delotte, J., et al. “MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis.” AJR Am J Roentgenol 196.5 (2011): 1206–13. DOI: 10.2214/AJR.10.4877. PMID: 21512093.
- Fusi, L., Cloke, B., Brosens, J.J. “The uterine junctional zone.” Best Pract Res Clin Obstet Gynaecol 20.4 (2006): 479–91. DOI: 10.1016/j.bpobgyn.2006.02.001. PMID: 16631411.
- Rasmussen, C.K., Hansen, E.S., Dueholm, M. “Two- and three-dimensional ultrasonographic features related to histopathology of the uterine endometrial-myometrial junctional zone.” Acta Obstet Gynecol Scand 98.2 (2019): 205–14. DOI: 10.1111/aogs.13484. PMID: 30317553.
- Tanos, V., Lingwood, L., Balami, S. “The importance of the junctional zone of the endometrium in human reproduction.” Hum Fertil (Camb) 25.1 (2022): 4–12. DOI: 10.1080/14647273.2020.1720316. PMID: 32024409.
- Singhal, N., Kudavelly, S., Ramaraju, G.A. “Deep Learning Based Junctional Zone Quantification using 3D Transvaginal Ultrasound in Assisted Reproduction.” Annu Int Conf IEEE Eng Med Biol Soc 2020 (2020): 2133–6. DOI: 10.1109/EMBC44109.2020.9175358. PMID: 33018428.
- Gibson, O.O., Makarchuk, O.M. “Peculiarities of treatment and prevention of recurrences in women with intrauterine pathologies.” Journal of Education, Health and Sport 11.1 (2021): 269–76. Available from: [https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.01.026/].
- Zhelezov, D.M. “Leiomyoma and reproductive function. Frontier of reproductology and modern obstetrics.” Achievements of Clinical and Experimental Medicine 2 (2021): 62–7. DOI: 10.11603/1811-2471.2021.v.i2.12204
- Xie, T., Xu, X., Yang, Y., et al. “The Role of Abnormal Uterine Junction Zone in the Occurrence and Development of Adenomyosis.” Reprod Sci 29.10 (2022): 2719–30. DOI: 10.1007/s43032-021-00684-2. PMID: 34515984.
- Maged, A.M., Ramzy, A.M., Ghar, M.A., et al. “3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles.” Eur J Obstet Gynecol Reprod Biol 212 (2017): 160–5. DOI: 10.1016/j.ejogrb.2017.03.035. PMID: 28376433.
- Harmsen, M.J., Van den Bosch, T., de Leeuw, R.A., et al. “Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure.” Ultrasound Obstet Gynecol 60.1 (2022): 118–31. DOI: 10.1002/uog.24786. PMID: 34587658; PMCID: PMC9328356.
- Harmsen, M.J., Trommelen, L.M., de Leeuw, R.A., et al. “Multidisciplinary view on uterine junctional zone in uteri affected by adenomyosis: explaining discrepancies between MRI and transvaginal ultrasound images on a microscopic level.” Ultrasound Obstet Gynecol (2022). DOI: 10.1002/uog.26117. PMID: 36370446.
- Hunt, S., Abdallah, K.S., Ng, E., et al. “Impairment of Uterine Contractility Is Associated with Unexplained Infertility.” Semin Reprod Med 38.1 (2020): 61–73. DOI: 10.1055/s-0040-1716409. PMID: 33058089.
- Huang, J.H., Duan, H., Wang, S., Wang, Y.Y. “Estrogen 17β estradiol accelerates the proliferation of uterine junctional zone smooth muscle cells via the let 7a/Lin28B axis in adenomyosis.” Mol Med Rep 23.5 (2021): 337. DOI: 10.3892/mmr.2021.11976. PMID: 34227673.
- Meylaerts, L.J., Wijnen, L., Grieten, M., et al. “Junctional zone thickness in young nulliparous women according to menstrual cycle and hormonal contraception use.” Reprod Biomed Online 34.2 (2017): 212–20. DOI: 10.1016/j.rbmo.2016.10.013. PMID: 27894894.
- Sun, F.Q., Duan, H., Wang, S., Li, J.J. “17β-Estradiol Induces Overproliferation in Adenomyotic Human Uterine Smooth Muscle Cells of the Junctional Zone Through Hyperactivation of the Estrogen Receptor-Enhanced RhoA/ROCK Signaling Pathway.” Reprod Sci 22.11 (2015): 1436–44. DOI: 10.1177/1933719115584447. PMID: 25940707.
- Huang, M., Li, X., Guo, P., et al. “The abnormal expression of oxytocin receptors in the uterine junctional zone in women with endometriosis.” Reprod Biol Endocrinol 15.1 (2017): 1. DOI: 10.1186/s12958-016-0220-7. PMID: 28049501; PMCID: PMC5209923.
- Wang, S., Li, B., Shen, X., et al. “The cannabinoid receptor CB1 affects the proliferation and apoptosis of adenomyotic human uterine smooth muscle cells of the junctional zone: a mechanism study.” Reprod Biol Endocrinol 19.1 (2021): 16. DOI: 10.1186/s12958-020-00690-0. PMID: 33531043; PMCID: PMC7852156.
- Zhang, Y., Yu, P., Sun, F., et al. “Expression of oxytocin receptors in the uterine junctional zone in women with adenomyosis.” Acta Obstet Gynecol Scand 94.4 (2015): 412–8. DOI: 10.1111/aogs.12595. PMID: 25627343.
- Shen, X., Duan, H., Wang, S., et al. “Expression of Cannabinoid Receptors in Myometrium and its Correlation With Dysmenorrhea in Adenomyosis.” Reprod Sci 26.12 (2019): 1618–25. DOI: 10.1177/1933719119833483. PMID: 30832539.
- Leyendecker, G., Wildt, L., Laschke, M.W., Mall, G. “Archimetrosis: the evolution of a disease and its extant presentation: Pathogenesis and pathophysiology of archimetrosis (uterine adenomyosis and endometriosis).” Arch Gynecol Obstet 307.1 (2023): 93–112. DOI: 10.1007/s00404-022-06597-y. PMID: 35596746; PMCID: PMC9836992.
- Pavličev, M., Romero, R., Mitteroecker, P. “Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma.” Am J Obstet Gynecol 222.1 (2020): 3–16. DOI: 10.1016/j.ajog.2019.06.043. PMID: 31251927; PMCID: PMC9069416.
- Royal College of Obstetricians and Gynaecologists. Management of Endometrial Hyperplasia. Green-top Guideline No. 67 RCOG/BSGE Joint Guideline (2016). Available from: [https://www.rcog.org.uk/media/knmjbj5c/gtg_67_endometrial_hyperplasia.pdf].
- Singh, S.S., Calaf Alsina, J., Vannuccini, S., et al. “Clinical perspectives on the menstrual pictogram for the assessment of heavy menstrual bleeding.” Hum Reprod Open 2022.4 (2022): hoac048. DOI: 10.1093/hropen/hoac048
- Magnay, J.L., O’Brien, S., Gerlinger, C., Seitz, C. “A systematic review of methods to measure menstrual blood loss.” BMC Womens Health 18.1 (2018): 142. DOI: 10.1186/s12905-018-0627-8. PMID: 30134884; PMCID: PMC6106944.
- Sobczuk, K., Sobczuk, A. “New classification system of endometrial hyperplasia WHO 2014 and its clinical implications.” Prz Menopauzalny 16.3 (2017): 107–11. DOI: 10.5114/pm.2017.70589. PMID: 29507578; PMCID: PMC5834925.
- Munro, M.G., Critchley, H.O.D., Fraser, I.S.; FIGO Menstrual Disorders Committee. “The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.” Int J Gynaecol Obstet 143.3 (2018): 393–408. DOI: 10.1002/ijgo.12666. Erratum in: Int J Gynaecol Obstet 144.2 (2019): 237. PMID: 30198563.
- Pandey, D., Kummarapurugu, S.V., Sayyad, M.G. “A Novel Non Invasive Screening Tool for Triaging Endometrial Pathologies in Abnormal Uterine Bleeding: Diseases of Endometrium – Evaluation and Risk Scoring.” Gynecol Minim Invasive Ther 7.4 (2018): 183–4. DOI: 10.4103/GMIT.GMIT_73_18. PMID: 30306041; PMCID: PMC6172876.
- Fetisov, V.S. Package of statistical data analysis STATISTICA. Nizhyn: publishing house of Nizhyn Mykola Gogol State University (2018): 102 p.
- Tanos, V., Lingwood, L., Balami, S. “Junctional Zone Endometrium Morphological Characteristics and Functionality: Review of the Literature.” Gynecol Obstet Invest 85.2 (2020): 107–17. DOI: 10.1159/000505650. PMID: 31968333.
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Copyright (c) 2023 І.З. Гладчук, Н.М. Рожковська, В.Г. Марічереда, І.С. Ломакіна, І.В. Шпак, Д.М. Железов
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