Endometriosis and adenomyosis

Endometriosis and adenomyosis 

Updated: 12/16/2020

© Jun Wang, MD, PhD

General features
  • Benign endometrial mucosa (glands and stroma) in locations outside uterine cavity
  • Chronic inflammatory, estrogen-dependent disease
  • Reproductive age with active hypothalamic-pituitary-ovarian axis function
  • Most common site: ovaries
  • Adenomyosis: benign endometrial tissue in myometrium
  • Associated with endometrioid type and clear cell type ovarian adenocarcinoma
Clinical presentations
  • Pain (dysmenorrhea)
  • Infertility
Key pathogenesis
    • 4 hypothesis
    • Regurgitation: Expulsion of endometrial tissue along fallopian tube during menstruation
    • Benign metastasis: Spread of benign endometrial tissue in a similar means of tumor metastasis
    • Extrauterine stem/progenitor cells: Extrauterine stem/progenitor cell differentiation in to endometrial tissue
    • Metaplasia: Transformation of other type of tissue into endometrial tissue
    Key pathological findings
    Molecular abnormalities
    • May harbor PTEN and ARID1A mutation
    Treatment
    • Hormonal: Gonadotropin-releasing hormone (GnRH) agonists, progestins, oral contraceptive pills, and androgens
    • Surgery


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