A clinicopathological study of the relationship between adenomyosis and other hormone-dependent uterine lesions

Abstract

Aim: The aim of this study was to investigate the relationship between adenomyosis, endometrial adenocarcinoma, hyperplasia and uterine leiomyomas.

Material and methods: 135 consecutive hysterectomy specimens showing adenomyosis and 82 consecutive cases of endometrial adenocarcinoma were studied in our laboratory in the last 5-year period. The histological sections of all cases were reviewed and in the cases with adenocarcinoma, the type of cancer, the degree of differentiation and the depth of myometrial invasion were recorded. In the adenomyosis group the presence of any other lesions, the extension of adenomyosis and the morphology of the adenomyotic glands were recorded. In ten random cases of adenomyosis, the presence of estrogens and progesterone receptors was investigated by an immunohistochemical method of peroxidase-antiperoxidase and DAB chromogen. In ten cases of this group the expression of E-cadherin was studied immunohistochemocally by an avidin-viotin method and DAB chromogen.

Results: In 47/135 cases of adenomyosis adenomatous hyperplasia coexisted (34.8%) and in 86/135 cases of leiomyomas (63.7%). In 31/82 cases of adenocarcinoma there was adenomyosis as well (37.8%), in 4/82 cases malignant changes in foci of adenomyosis were observed and in 1/82 cases the malignancy arose in a focus of adenomyosis. Immunohistochemical studies showed the presence of progesterone receptors in the glandular cells of adenomyosis in 9/10 cases and of estrogen receptors in 2/10 cases. In all study cases (10/10) a positive membrane immunoreaction was observed; focal (6/10) and extensive (4/10).

Conclusion: The high frequency of coexistence between adenomyosis and other hormone-dependent uterine lesions is indicative of the presence of a hormonal factor in the pathogenesis of adenomyosis.