Adenomyosis:A Clinico-pathological Study

Abstract

Background: Adenomyosis is defined by the presence within the myometrium of benign endometrial glands and stroma. Several theories have evolved to explain the pathogenesis of adenomyosis. A third of adenomyosis cases are asymptomatic. Symptoms are however non-specific and are generally related to abnormal vaginal bleeding, pain, infertility, and feeling of pelvic mass. Adenomyosis do coexist with other pathological entities. Diagnosis is achieved through imaging and histology. Treatment could be medical, surgical or a combination of both. The objective of this study was to analyze diagnosed st stcases of adenomyosis, between 1 January 2007, and 31 December 2013 at the Jos University Teaching Hospital in relation to patient's age, common symptoms, and coexisting utero-cervical pathologies.

Methodology: The data from the Medical Records department, Radiology department, and Histopathology department at the Jos University Teaching Hospital, Jos, were mobilized. The information retrieved for each case included: age, symptoms, and coexisting utero-cervical lesions. Archival slides were reviewed to histologically confirm the diagnosis of adenomyosis. In cases with missing slides, archival tissue blocks were retrieved, sectioned into 5µm slides, stained with haematoxylin and eosin, and reviewed microscopically to confirm the diagnosis of adenomyosis.

Results: One hundred and fifty seven (157) cases of adenomyosis were diagnosed at the Jos University Teaching Hospital. All cases were histologically diagnosed retrospectively after hysterectomy. The cases were divided into two broad groups: 107(68.2%) cases with adenomyosis only (A), and 50(31.8%) with coexistence of adenomyosis and leiomyoma (AL). The mean age for the general study population was 43.57+8.56, while those for A and AL groups were 44.37+9.12, and 41.86+6.99 respectively. The age group 41-50 years had the highest number of cases in both the A and AL groups: 53(49.5%) and 21(42.0%) cases respectively. The most frequent symptom was menorrhagia, occurring in 87(81.3%), 43(86.0%), and 130(82.8%) cases in the A, AL, and general population respectively.

Conclusion: Adenomyosis is commoner in the fourth decade of life. It commonly coexists with leiomyoma with menorrhagia being the most frequent symptom. Retrospective histology after a hysterectomy is the diagnostic tool for the disease in our center.