Clinical-morphological features of lobular, nodular and diffuse forms of adenomyosis

Abstract

The purpose of the study was to investigate clinical, morphological and immunohistochemical features and pathogenetic interrelationship between focal, nodular and diffuse forms of adenomyosis. There was investigated surgical samples of removed uterines and their fragments; patients were divided into 3 groups, the 1st group was consisted of 16 cases with focal adenomyosis, the 2nd - 24 females with nodular form of adenomyosis, the 3rd - 21 female with diffuse form of adenomyosis. All patients were underwent general clinical examination, instrumental and laboratory observation with the aim of the verification of the diagnosis. There were executed macro- and microscopic immunohistochemical investigations of fragments of the tissue from the zone of endometrioid heterotopias, surrounding myometrium and eutopic endometrium. There were used antibodies: Ki-67, PTEN, ER, PR (“DAKO”), p16 (“Roshe”). There was established the significant increase in the expression of proliferation marker Ki-67, in parallel with a decrease in the expression level of PTEN, ER, PR from the focal to the nodular and diffuse forms of adenonomyosis. Thus it seems to be possible to consider focal, nodular and diffuse forms of adenomyosis as forms-phases of adenomyosis, that according both to histological characteristics of adenomyosis and immunohistochemical markers offocal and nodular forms may antedate the diffuse form of adenomyosis, that is also confirmed by the detection of a combination of all of these forms. Diffuse form of adenomyosis can be assumed to have the highest potential for the growth and dissemination of the pathological process in the uterine.