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Semin Reprod Med 2020; 38(02/03): 108-118
DOI: 10.1055/s-0040-1718922
Review Article

Pathology and Pathogenesis of Adenomyosis

Maria Facadio Antero
1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Ayse Ayhan
2   Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
James Segars
1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Ie-Ming Shih
1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations Funding This study is supported by an NIH grant RO1HD096147 and by the Richard W. TeLinde Endowment, Department of Gynecology and Obstetrics, Johns Hopkins University.
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Abstract

Adenomyosis represents a unique pathophysiological condition in which normal-appearing endometrial mucosa resides within myometrium and is thus protected from menstrual shedding. The resulting ectopic presence of endometrial tissue composed of glands and stroma is thought to affect normal contractile function and peristalsis of uterine smooth muscle, causing menometrorrhagia, infertility, and adverse obstetric outcomes. Since the first description of adenomyosis more than 150 years ago, pathologists have studied this lesion by examining tissue specimens, and have proposed multiple explanations to account for its pathogenesis. However, as compared with endometriosis, progress of adenomyosis research has been, at best, incremental mainly due to the lack of standardized protocols in sampling tissue and a lack of consensus diagnostic criteria in pathology practice. Despite these limitations, recent advances in revealing the detailed anatomy and biology of eutopic endometrium offer an unprecedented opportunity to study this common but relatively understudied disorder. Here, we briefly summarize the pathological aspects of adenomyosis from an historical background, and discuss conventional morphology and recent tissue-based molecular studies with a special emphasis on elucidating its tissue of origin from a pathologist's perspective. We also discuss unmet needs in pathology studies that would be important for advancing adenomyosis research.

Keywords

adenomyosis - endometriosis - pathology - pathogenesis


Publication History

Article published online:
20 October 2020

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