Abstract Issue

Volume 12 Issue 4 ( October-December ) 2023

Original Articles

Adenomyosis and uterine bleeding: Clinicopathological correlation
Dr. Vani Gupta,Dr. Shiwani Gupta,Dr. Amit Kumar,Dr. Megha Gupta

Introduction: Adenomyosis is diagnosed histologically when benign endometrial glands and stroma are visualised penetrating the myometrium and surrounding myometrium being hypertrophic and hyperplastic. This condition can be asymptomatic or may be related to various clinical symptoms such as pain during menstruation (dysmenorrhea), heavy or prolonged menstrual bleed (menorrhagia) and pelvic pain. The association between adenomyosis and these clinical features singularly or in conjunction have been variably documented in previous studies. Aims and Objectives:To evaluate depth and number of adenomyotic glands in myometrium and clinically correlate these with menorrhagia and dysmenorrhoea. Materials and Methods: Hysterectomy specimen’s received between August2022 and July2023 were reviewed along with relevant clinical details as per patient’s record files. 82 samples with adenomyosis were included in the study after applying the inclusion and exclusion criteria. Depth of penetration of adenomyosis was categorized as Category1: upto inner 1/3rd of myometrium penetrated and Category 2: more than 1/3rd of myometrial thickness penetrated, from endometrial surface. The average numbers of adenomyotic glands per low power field (x 40 magnification), were calculated as an average of five fields with maximum glandular distribution were grouped as Group 1: 1-3 glands/ LPF and ≥ 3 glands/LPF. Relationship between these parameters and menorrhagia and dysmenorrhoea was evaluated. All the statistical analysis were done using spss software ver 22.0 the results were considered significant when p value was <0.05. Results: The study included 82 hysterectomy samples, as per inclusion and exclusion criteria.Presence of menorrhagia significantly correlated with depth of endometrial glandular invasion into myometrium (p =0.001) with menorrhagiabeing present in 28%category 1 invasion and 66% in category 2 invasion. Dysmenorrhea was documented as presenting complaint in 24% of women in category 1 vs 47% in category 2, with significant correlation. (p=0.046). Menorrhagia also significantly correlated with average number of adenomyotic glands per low power field (p=0.001), menorrhagia being present in 28 cases with ≥ 3 adenomyotic glands/LPF and 17 cases of 1-3 glands/ LPF, however there was no significant correlation between dysmenorrhea and average number of adenomyotic glands (p=0.064). Conclusion: Menorrhagia and dysmenorrhoea both correlated with the level of myometrial involvement by adenomyosis suggesting that the deeper the myometrium is penetrated the more are the symptoms. Menorrhagia also showed significant positive correlation with glandular density however dysmenorrhoea was independent of number of glands in the myometrium.

 
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