This paper is a review based on information found in literature. The analysis was limited to articles in English language published between January 1st, and November 13th, on PubMed. In this review, we discuss the current trends in the management of uterine adenomyosis, especially ultrasound and MRI diagnosis.
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Adenomyosis remains an underdiagnosed condition. Through a careful description of the sonographic aspects of adenomyosis and endometrial cancer pubmed a standardized classification, we can improve the diagnosis rates in women of reproductive age. Keywords adenomyosis, transvaginal ultrasonography, magnetic resonance Rezumat Adenomioza uterină este o patologie ginecologică ce este caracterizată de prezenţa insulelor ectopice de ţesut endometrial în miometru.
Această lucrare reprezintă o revizie a literaturii, prin intermediul platformei PubMed. Analiza a fost limitată la articole în limba engleză, publicate între 1 ianuarie şi 13 noiembrie În această recenzie a literaturii am discutat tendinţele curente în managementul adenomiozei uterine, punând accentul pe rolul ecografiei şi al rezonanţei magnetice în diagnosticul afecţiunii.
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Adenomioza rămâne o boală subdiagnosticată. Printr-o descriere atentă a aspectelor ecografice ale adenomiozei şi prin utilizarea unei clasificări, putem îmbunătăţi ratele de diagnostic la femeile de vârstă reproductivă. Two main theories have been proposed to explain the origin and pathogenesis of adenomyosis: the first theory relies on the invagination of the endometrial basalis into the myometrium as a result of activation of the tissue injury and repair mechanism TIARwhile the second theory states that the adenomyotic lesions result from metaplasia of displaced embryonic pluripotent müllerian residues or differentiation of adult stem cells 2.
The importance of the diagnosis of this pathology is due to the fact that adenomyosis is often associated with hormone-dependent pelvic lesions 3. The symptomatology is present in endometrial cancer pubmed cancer pubmed of three women, and its severity is correlated with increasing ectopic foci endometrial cancer pubmed the expansion of the invasion 4,5. The typical symptoms include abnormal uterine bleeding, pelvic pain and infertility 6. Until the introduction of noninvasive ultrasound and magnetic resonance techniques, the diagnosis was relying on histopathologic examination of post-hysterectomy endometrial cancer pubmed.
Since then, several studies have confirmed the high sensitivity and specificity for both two-dimensional transvaginal sonography TVS and magnetic resonance imaging MRI In this review we discuss the management of uterine adenomyosis with a special focus on the role of ultrasound and MRI in diagnosis.
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Multiparous status has a major role in the development of adenomyosis because under the action of the trophoblast in the myometrium, the junctional zone may be interrupted mechanically Oral contraceptives are not associated with adenomyosis, but it has been found more common in women who use the selective estrogen endometrial cancer pubmed modulator tamoxifen Diagnosis The gold standard for the diagnosis of adenomyosis is the histological examination of a hysterectomy specimen.
Focal adenomyosis is different from adenomyoma. Pathologists define this as focal adenomyosis with additional compensatory hypertrophy of the surrounding myometrium. The implementation of modern imaging techniques, such as transvaginal ultrasonography TVUS and magnetic resonance imaging, has granted a noninvasive way to diagnose adenomyosis The ultrasonography endometrial cancer pubmed is widely available in an office setting, it is relatively economical, it requires no preparation, it has no contraindications and it is relatively accurate, being the preferred imaging technique in gynecology.
The role of ultrasound and MRI in diagnosis Adenomyosis can be diagnosed with a high degree of accuracy with the rise of high-resolution imaging techniques. The imaging signs revealed with endovaginal ultrasonography US and magnetic resonance imaging correlate with various aspects of this disease at histopathologic analysis.
Reinhold et al. The ultrasound features specific for adenomyosis described in the literature are very various and subtle.
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In cases with focal adenomyosis, sonographic images may have similarities to those of leiomyomas. The arguments for the diagnosis of adenomyosis presented by Timmerman in included: uneven ultrasound texture and poorly differentiated margins, presence of elliptical shape at the expense of globular shape, lack of edge shadowing, presence of echogenic nodules, absence of circular endometrial cancer pubmed on the edge of the lesion and presence of linear striations from the endometrium to the myometrium, along with the absence of vascularization at the edge of the lesion Figure 1 Subsequently, the MUSA Morphological Uterus Sonographic Assessmenta consensus statement on terms, definitions and measurements to describe the sonographic features of the myometrium, laid the endometrial cancer pubmed for studies that had different myometrial pathologies.
Thereby, in the same year, Van Den Bosch et al. InVan den Bosch et al. Three-dimensional transvaginal sonographic signs of adenomyosis are based on the evaluation of the junctional area on the acquired volume of the uterus in order to obtain the coronal view. In comparison with the conventional two-dimensional transvaginal sonography 2D-TVSthree-dimensional transvaginal sonography 3D-TVS seems to be more accurate in detecting adenomyosis Figure 2.
As mentioned before, magnetic resonance imaging can diagnose adenomyosis with high accuracy. Figure 1. Focal adenomyosis — vascularity, poorly differentiated margins and presence of echogenic nodules Figure 2.
Three-dimensional transvaginal sonographic signs of adenomyosis Hysteroscopy is a method of diagnosis and treatment of adenomyosis with the major advantage of allowing the direct visualization of the uterine cavity, as well as taking biopsies for the histopathological examination. It should be noted, however, that hysteroscopy has the disadvantage of having limited access to the superficial level of the endometrium.
The suggestive aspects for adenomyosis that can be detected hysteroscopically are: the irregular endometrium that associates tiny openings on the surface, hypervascularization, strawberry pattern, dark blue or chocolate colored bleeding cystic lesions.
By hysteroscopy, endometrial cancer pubmed is possible to remove superficial focal adenomyosis or to eliminate hemorrhagic cystic lesions with a diameter of less than 1. A minimally invasive myometrial resection can also be performed. It should not be overlooked that resectoscopic treatment is not indicated for women who want a future pregnancy. As an adjuvant or alternative therapy, it can be considered endometrial cancer pubmed local medical therapy by implanting a levonorgestrel-releasing intrauterine device.
The continuous elimination of levonorgestrel in the uterine mucosa is meant to induce regression of endometrial cancer pubmed lesions and improve the symptomatology 18, Conclusions With the introduction of newer and better performing indirect imaging techniques, adenomyosis has become a pathology that can be diagnosed in a presurgical phase. The clinical interpretation is considered difficult due to the high incidence of concomitant pathology such as endometriosis and fibroids. Tratamentul enterobiozei în pastile pentru adulți the new methods of ultrasound and magnetic resonance imaging and using a standardized classification system and histological confirmation, we can endometrial cancer pubmed adenomyosis.
Conflict of interests: The authors declare no conflict of interests. Introduction: uterine adenomyosis, another enigmatic disease of our time. Fertil Steril. Pathogenesis of uterine adenomyosis: invagination or metaplasia? An update on adenomyosis. Diagn Interv Imaging. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol. Correlations between extent and spread of adenomyosis and clinical symptoms.
Diagnosticul adenomiozei uterine la pacientele de vârstă reproductivă
Gynecol Obstet Endometrial cancer pubmed. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Habiba M, Benagiano G Eds.
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Uterine adenomyosis. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.
Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy.
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Etapele procesului de elaborare Data reviziei Istoricul natural al endometriozei5. Evoluția endometriozei Diagnosticarea și evaluarea clinică a endometriozei5.
Shwayder J, Sakhel K. Imaging for uterine myomas and adenomyosis. J Minim Invasive Gynecol. Adenomyosis in postmenopausal breast cancer patients treated with Tamoxifen: A new entity?
Gynecol Oncol. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment MUSA group.
Endometrial cancer pubmed
Ultrasound Obstet Gynecol. Sonographic classification and reporting system for diagnosing adenomyosis. MRI for adenomyosis: a pictorial review. Insights Imaging.
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Role of medical therapy in the management of uterine adenomyosis. The role of hysteroscopy in the diagnosis and treatment of adenomyosis. Biomed Res Int. Articole din endometrial cancer pubmed anterioare Raport de examinare ginecologică bazat pe consensul grupurilor internaţionale de studiu al tumorilor Roxana-Elena Bohîlţea, L. Bohîlțea, Natalia Turcan, Gh.
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Turcan, Prof. Radu Vlădăreanu, C. Ionescu, Monica Mihaela Cîrstoiu, Prof. Bordea, A. Elvira Brătilă O definiţie histologică clasică pentru adenomioză este invazia miometrului de glande sau stromă endometrială mai mult de 2,5 mm de la nivelul zon