Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×10⁵, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.
Female ; Humans ; Adult ; Middle Aged ; Adenomyosis/pathology* ; Dysmenorrhea/therapy* ; Menorrhagia/pathology* ; Endometriosis/therapy* ; Retrospective Studies ; Infertility/complications* ; Magnetic Resonance Imaging

Adenomyosis ; metabolism ; pathology ; Adult ; CA-125 Antigen ; metabolism ; Endometrial Hyperplasia ; metabolism ; pathology ; Endometrial Neoplasms ; metabolism ; pathology ; Endometriosis ; metabolism ; pathology ; Female ; Humans ; Hyperplasia ; metabolism ; pathology ; Middle Aged

OBJECTIVE: To evaluate the correlation of magnetic resonance (MR) T₂-weighted image (T₂WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation. METHODS: Based on the presence or absence of patchy hyperintense foci on preoperative MR T₂WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups. RESULTS: A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05). CONCLUSION The signal characteristics of adenomyosis on T₂WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.
Female ; Humans ; Adenomyosis/pathology* ; Dysmenorrhea ; Cohort Studies ; Propensity Score ; High-Intensity Focused Ultrasound Ablation/methods* ; Treatment Outcome

OBJECTIVE: This study is to compare the baseline characteristics and symptoms between groups with leiomyoma only (group M; myoma group), adenomyosis only (group A; adenomyosis group), and leiomyoma and adenomyosis together (group B; group for both disease). METHODS: Selected patients were who received total abdominal hysterectomy, laparoscopy-assisted vaginal hysterectomy, or total laparoscopic hysterectomy from January 2014 to December 2015, and whose pathology result showed leiomyoma (n=74), adenomyosis (n=27), or both (n=63). Baseline characteristics and symptoms were reviewed from the medical records. Researched characteristics included patients' age, degeneration of leiomyoma, endometrial hyperplasia, endometriosis, weight of the removed uterus, menopause before the surgery, method of the surgery, necessity for blood transfusion before and after the surgery, difference of hemoglobin level before and after the surgery, and number of gravida, para, and abortion. RESULTS: Eleven symptoms were checked. Thirty-eight point four percent of total subject had uterine leiomyoma and adenomyosis at the same time. Number of abortion was higher in the group B. The group B showed a tendency of presenting more menorrhagia, dysfunctional uterine bleeding, acute lower abdominal pain, and urinary frequency. Symptoms related to mass effect seem to be relative to uterine leiomyoma, and symptoms related to menorrhagia seems to be relative to adenomyosis. The group M showed suddenly growing mass symptoms, and was more likely to have massive hemorrhage during the surgery. It is hard to differentiate coexistence of uterine leiomyoma and adenomyosis from each disease. CONCLUSION: Coexistence of two disease exhibits mixed symptoms of each disease, but shows different tendency.
Abdominal Pain ; Adenomyosis ; Blood Transfusion ; Endometrial Hyperplasia ; Endometriosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Medical Records ; Menopause ; Menorrhagia ; Methods ; Metrorrhagia ; Myoma ; Pathology ; Retrospective Studies ; Uterus

Opinions on ovariohysterectomy (OHE) of bitches vary depending on region and country. In this descriptive, prospective cross-sectional study, uterine tracts and ovaries exhibiting gross pathologic findings (n = 76) were collected post-surgery from a reference population of 3,600 bitches (2.11% incidence) that underwent elective OHE during September to November 2013 and evaluated by histopathology examination. Data were evaluated by using descriptive statistics and chi-squared tests. Bitches were of crossbred background with average age 5 years (range 0.6–8.0 years) and most were nulliparous (69.7%) with no anamnesis of reproductive diseases (81.6%). Frequencies of proestrus, estrus, and diestrus were 42.1%, 6.6%, and 19.7%, respectively. The presence of mammary gland masses (5.3%) significantly correlated with histopathologic findings in ovaries and age of the bitch (p < 0.05). Predominant uterine histopathologies included cystic endometrial hyperplasia, periglandular fibrosis, lymphoplasmocytary endometritis, and adenomyosis (19.7%, 14.5%, 4.0%, and 2.6%, respectively). In ovaries, hyperplasia of rete ovarii, follicular cysts, oophoritis, adenoma of the rete ovarii, cysts of superficial structures, and granulosa cell tumors (10.5%, 10.5%, 7.9%, 4.0%, 2.6%, and 2.6%, respectively) were observed. The results reveal the presence of subclinical pathologies in healthy bitches, suggesting that OHE at an early age is beneficial for prevention of reproductive pathologies.
Adenoma ; Adenomyosis ; Animals ; Cross-Sectional Studies* ; Diestrus ; Dogs* ; Endometrial Hyperplasia ; Endometritis ; Estrus ; Female ; Fibrosis ; Follicular Cyst ; Granulosa Cell Tumor ; Hyperplasia ; Mammary Glands, Human ; Oophoritis ; Ovary* ; Pathology ; Proestrus ; Prospective Studies ; Uterus*

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.
Adenomyosis ; Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Contraception ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Leiomyoma ; Mass Screening ; Menopause ; Mortality ; Obstetrics ; Pathology ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

OBJECTIVE: To analyse the clinical aspects of vaginal approach for gynecologic pelvic surgery, we evaluated age distribution, parity, indications for hysterectomy, postoperative pathology, operating time, bleeding amount, weight of uterus, postoperative complications. resected uterus weight, operating time and bleeding amount based on operative procedure type. METHODS: We reviewed the medical records of the 136 patients who underwent vaginal approach for gynecologic pelvic surgery for the indications other than uterine prolapse from Jan. 1998 to April. 1998, and from July. 1999 to Sep. 2001 at Chosun University Hospital. RESULTS: We performed 136 cases of vaginal approach for gynecologic pelvic surgery. We performed 132 cases of total vaginal hysterectomy, 4 cases of transvaginal ovarian cystectomy, a high increased rate of vaginal approach for gynecologic pelvic surgery significantly. The most common indication for vaginal approach for gynecologic pelvic surgery was uterine leiomyoma (63.2%), followed by HSIL, adenomyosis, MIC of the cervix, and ovarian cyst. The operating time was within 90 min in almost cases (47.1%). The most common postoperaive pathologic finding was uterine leiomyoma (47.1%), followed by adenomyosis, uterine leiomyoma with adenomyosis, MIC of the cervix, HSIL, LSIL, ovarian serouscys- tadenoma, and endometrioma. There were 4 cases (2.9%) of cuff cellulitis, 2 cases of pelvic cellulitis (1.5%), 3 cases of hematoma formation (2.2%), 1 case of laparatomy (0.7%) as postoperative complications. etc. CONCLUSION: Vaginal approach for hysterectomy and ovarian cystectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widened to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, Vaginal approach for hysterectomy and ovarian cystectomy would be the preferred method of gynecologic pelvic surgery in the future.
Adenomyosis ; Age Distribution ; Animals ; Bleeding Time ; Cellulitis ; Cervix Uteri ; Cystectomy ; Endometriosis ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Medical Records ; Ovarian Cysts ; Parametritis ; Parity ; Pathology ; Postoperative Complications ; Prolapse ; Surgical Procedures, Operative ; Uterine Prolapse ; Uterus

OBJECTIVE: We have performed Classic Intrafascial Supracervical Hysterectomy (CISH) since April 1993, so we are to report the clinical results of CISH for 10 years, and introduce the technical aspects of new CISH. METHODS: A retrospective analysis on 470 cases of CISH (conventioal and new method) was carried out including age, parity, operating time, blood loss, uterine weight, pathologic results, complications and postoperative recovery. RESULTS: The mean age was 44.8 years (range 25-68), parity 2.23 (0-9), operating time 131 minutes (70-310), mean blood loss 148 mL (20-1000) and mean uterine weight was 306 gram (90-880). The most common uterine pathology was uterine leiomyoma (49.3%) and there were adenomyosis (15.5%), leiomyoma with adenomyosis (12.5%), chronic cervicitis (5%) and so on. Intraoperative complications included one case of bladder injury due to thick adhesion and 6 cases of bleeding requiring transfusion. Postoperative complications included 5 cases of cervical coring site bleeding, 2 cases of febrile complications, 2 cases of trocar site bleeding, 1 case of transient nerve injury of lower extremity, and 1 case of urinary tract infection. The mean hospital stay was 5.3 days (3-10). two hundreds and seventy eight patients of 470 had been followed for cervical pathology, and no pathologic findings except 3 cases of mild dysplasia were shown. CONCLUSION: Classic intrafascial supracervical hysterectomy, a minimally invasive organ-preserving procedure indicated for benign uterine disease, is associated with few operative complications and low morbidity, and the disadvantages of conventional Semm's CISH technique can be overcome by new CISH technique using triple ligation method.
Adenomyosis ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Intraoperative Complications ; Leiomyoma ; Length of Stay ; Ligation ; Lower Extremity ; Parity ; Pathology ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments ; Urinary Bladder ; Urinary Tract Infections ; Uterine Cervicitis ; Uterine Diseases